Postmenopausal Hypertension

ypertension in women is often undiagnosed or inade- quately treated, especially after menopause when cardiovascular risk increases.In premenopausal women, endogenous estrogens maintain vasodilation and thus contribute to blood pressure control.Aging and the loss of endogenous estrogen production after menopause are accompanied by increases in blood pressure, contributing to the high prevalence of hypertension in older women.Currently, Ϸ75% of postmenopausal women in the United States are hypertensive.The high prevalence of obesity, the lack of regular physical exercise, and dietary salt are important factors contributing to and aggravating postmenopausal hypertension.In view of the ongoing population aging throughout the world, diagnosis and treatment of hypertension in postmenopausal women are important to reduce the excess burden of associated cardiovascular disease and to improve outcomes of potentially fatal complications such as stroke and myocardial infarction.This article discusses current knowledge about the mechanisms and therapeutic issues related to postmenopausal hypertension. Hypertension: Important Determinant of Cardiovascular Risk in WomenMore than 25% of the female adult world population is hypertensive. 1Elevations in blood pressure in women are related to cardiovascular risk (Figure, panel A), 2,3 with the prevalence of hypertension being particularly high among women aged Ն60 years. 1 In the United States, Ϸ75% of postmenopausal women are hypertensive. 4Hypertension is often accompanied by other cardiovascular risk factors, eg, obesity, dyslipidemia, and diabetes mellitus. 5It is noteworthy that the prevalence of hypertension-related cardiovascular complications is greater in postmenopausal women than in age-matched men. 6Indeed, these complications represent the leading cause of death in women. 6linical studies have documented beneficial effects of antihypertensive therapy on cardiovascular outcome, 5 even in patients Ն80 years of age. 7Overall recognition, control, and treatment of hypertension in postmenopausal women are still poor in primary care, and hypertension is often not being treated aggressively enough. 4,8 -10Thus, further improve-ments of medical and public health measures, awareness of patients and physicians, and improved information policies are needed.