Menopause is a natural physiological stage that any woman will experience, usually occurring between the ages of 45 and 55. However, in addition to common symptoms such as hot flashes, sleep disorders, mood swings, etc., many women also begin to notice that their blood pressure is higher than normal. Many people feel worried but do not understand the underlying cause behind this change.
In fact, modern medical research has shown that high blood pressure in postmenopausal women is not simply the result of the aging process, but also due to many physiological and hormonal factors specific to this stage.
Causes of Postmenopausal Hypertension
Here are the main reasons why menopause can lead to hypertension:
1. Arterial stiffness
The increase in systolic blood pressure (the top number) is mainly due to the stiffness of the arterial wall that increases with age. Blood pressure increases more rapidly in women in their 50s than in men, probably due in large part to estrogen deficiency.
2. Increased RAS activation
Decreased estrogen leads to an increase in the renin-angiotensin system (RAS) in the kidneys. This is a specialized enzyme system that controls blood pressure in the human body. Increased RAS activity leads to higher levels of angiotensin-11 and aldosterone, which cause sodium retention, vasoconstriction, and increased blood pressure.
3. Effects of HRT on the kidneys
Oral HRT increases the concentration of the protein angiotensinogen, which causes vasoconstriction, increasing blood pressure. However, it also reduces renin levels, which largely counteracts this blood pressure-raising effect.
4. Increased salt sensitivity
Postmenopausal women have increased salt sensitivity – meaning their kidneys overreact to salt intake.
5. Being overweight or obese
Obesity leads to oxidative stress, insulin resistance and increased levels of systemic inflammation, all of which are linked to high blood pressure. In addition, obese postmenopausal women have increased sympathetic nervous system activity, which contributes to high blood pressure.
6. Metabolic syndrome
Menopause increases the risk of metabolic syndrome by 60%. The risk is highest in obese postmenopausal women, but metabolic syndrome can still develop in those with a BMI in the normal range.
Metabolic syndrome is a group of risk factors that increase the risk of cardiovascular disease. These include abdominal obesity, high blood pressure, high fasting blood sugar, high triglycerides, and low HDL (“good”) cholesterol. In a recent 2023 study, the risk of cardiovascular disease in postmenopausal women with metabolic syndrome was significantly increased by 13.8 times.
How to control high blood pressure in postmenopausal women?
Here are some effective tips:
1. HRT Does Not Cause High Blood Pressure
Currently, hormone replacement therapy (HRT) should not be prescribed solely to lower blood pressure, although it tends to have a blood pressure-lowering effect. HRT is prescribed to help women with menopausal symptoms, including hot flashes, night sweats, insomnia, fatigue, and confusion. However, it is thought to have additional benefits for cardiovascular disease. There are non-hormonal options for women who cannot take HRT.
2. Improve lifestyle factors
Women are advised to do what they can to reduce their risk of cardiovascular disease. This includes quitting smoking, losing weight, eating a healthy diet and exercising more.
2.1. Eat a healthy diet
Diet is extremely important. Women need to eat a diet low in salt and free of processed and ultra-processed foods. Heart-healthy foods include fresh fruit and vegetables – at least 5 – some say 10 a day – along with whole grains, nuts and seeds. Eating plenty of lean protein such as chicken or fish is important, as well as healthy unsaturated fats (from plants) such as olive oil, sunflower oil, rapeseed oil or avocado oil. Cut down on red meat. Avoid foods high in fat, sugar and salt – cook at home with good quality ingredients.
A great option in the Mediterranean diet meets all of these criteria.
2.2. Cut down on alcohol
Reduce your alcohol intake or stop altogether. Alcohol is empty calories. In the long run, alcohol increases blood pressure.
2.3. Reduce stress
Reduce stress in any way you can. This could be yoga, meditation or Tai Chi. Exercises like brisk walking help reduce stress. Hot and cold therapy is also helpful. Even reading for 30 minutes a day can help reduce stress. Make time to de-stress every day.
2.4. Improve your sleep
Get enough sleep. Many studies have shown that insomnia is linked to high blood pressure. Make sure you establish a good night’s sleep routine, relax before bed, have a dark, cool bedroom and a comfortable mattress. Turn off devices that emit blue light (TV, computer, iPad and smartphone) 2 hours before bedtime. Do not consume caffeine or alcohol within 6 hours of bedtime.
2.5 Take blood pressure medication as prescribed by your family doctor
High blood pressure can be treated with medication in the usual way. Postmenopausal women often have good blood pressure control with diuretics and angiotensin-converting enzyme (ACE) inhibitors.
