Postmenopausal Status Identifies a High-Risk Abpm Profile in Hypertensive Women: Daytime Bp Elevation, Riser Pattern, and Organ Damage

Objective: Menopause is associated with blood pressure dysregulation, yet the ABPM phenotype and its linkage to hypertension-mediated organ damage (HMOD) in real-world hypertensive women remain incompletely characterized. This study aims to delineate postmenopausal ABPM phenotypes and quantify their associations with vascular, renal, and cardiac HMOD, with particular emphasis on whether nighttime BP explains menopause-related HMOD differences.Design and method: In hypertensive women undergoing ABPM, participants were categorized as premenopausal (n=1412) or postmenopausal (n=4050). ABPM indices included daytime, nighttime, and 24-h SBP/DBP, pulse pressure, nocturnal hypertension, and SBP dipping patterns (dipper, non-dipper, riser). Associations of menopausal status with ABPM measures and HMOD were examined using multivariable models with age modeled flexibly and sequential covariate adjustment. For HMOD outcomes, an additional model further adjusted for nighttime SBP and non-dipping to assess the explanatory contribution of nocturnal BP phenotype. Results: Postmenopausal women exhibited higher ambulatory BP levels, particularly during daytime (daytime SBP 140.93±11.80 vs 137.10±11.67 mmHg; daytime DBP 84.55±8.56 vs 85.14±9.22 mmHg), p<0.01). Nocturnal hypertension was highly prevalent and similar between groups (96.7% in both; P=0.935). In adjusted analyses, postmenopausal status was associated with higher daytime SBP and DBP (approximately +2.8 and +2.5–2.7 mmHg, respectively). Postmenopausal status was also linked to a higher likelihood of a riser BP pattern (adjusted OR =1.75–1.77; 95% CI 1.06–2.94), whereas associations with nocturnal hypertension and non-dipping were not statistically significant after full adjustment. Regarding HMOD, postmenopausal status was associated with worse renal indices and cardiac remodeling (all P<0.001). Associations with baPWV and ABI were not significant. Importantly, additional adjustment for nighttime SBP and non-dipping minimally changed the estimates for renal impairment and cardiac structural measures, indicating that menopause-related HMOD differences were not fully explained by nocturnal BP phenotype. Conclusions: Postmenopausal hypertension in women is characterized by a daytime-predominant ambulatory BP profile, elevated pulse pressure, and a higher burden of HMOD. These differences persist beyond nocturnal SBP and dipping status, supporting menopause-specific pathophysiology and underscoring the clinical value of ABPM-guided risk stratification in postmenopausal hypertensive women.