Connecting postmenopausal vasomotor symptoms and blood pressure regulation: a role for the autonomic nervous system?

Menopause represents a particularly vulnerable stage in the female reproductive cycle accompanied by significant health impacts possibly contributing to the elevated risk of hypertension and cardiovascular disease (CVD) post-menopause (1, 2).Indeed, women traversing menopause experience undesirable body fat redistribution, weight gain, worsened lipid profiles, metabolic syndrome, negative vascular remodeling, impaired sleep, and vasomotor symptoms (VMS) (2).Many of these cardiometabolic and symptomological changes may also link to elevated blood pressure (BP) and aberrant autonomiccardiovascular regulation (3).Given that women may spend nearly 40% of their life postmenopause (2), identifying the pathways through which menopausal physiology may impair BP regulation serves to improve long-term health outcomes.While a multitude of menopausal symptoms can manifest, VMS are often noted.Notably, ≈80% of women experience VMS, which can last for 10 years (2).Further, VMS presence predicts greater longitudinal BP (4), though the direct mechanistic connections between VMS, BP regulation, and hypertension remain unclear (3).One such pathway involves the autonomic nervous system, whereby aging in women reduces parasympathetic control and augments sympathetic control, at rest and during stressors, contributing to increased BP (5).Therefore, in this issue of American Journal of Physiology -Heart and Circulatory Physiology, Stokes et al. (6) aimed to determine whether autonomic-cardiovascular function at rest and during the cold pressor test (CPT) is altered by VMS in postmenopausal women.This study recruited 69 postmenopausal women (≥12 months without menses; 43 with VMS; 26 without VMS).The researchers employed rigorous exclusion criteria, among which included: body mass index (BMI) ≥35 kg/m 2 ; history of cardiorespiratory diseases, except for untreated hypertension; autonomic dysfunction; diabetes; severe neurological conditions; sleep apnea; or use of medications that may alter autonomic function such as