Menopause and High Blood Pressure Risk

During menopause, as estrogen declines, you may lose the heart-protective qualities that estrogen provides, and it may be more challenging to keep your blood pressure within normal ranges. Even events like hot flashes, when they interfere with your sleep,  can make you even more vulnerable to high blood pressure. 

Blood pressure is the amount of force your blood uses to get through your arteries. When your heart pumps, it uses force to push oxygen-rich blood out to your arteries and bring it to your body’s cells and tissues. If your blood pressure is too high, it can cause health issues. High blood pressure is a major risk factor for cardiovascular disease.

However, menopausal women are not doomed to suffer from high blood pressure. Here we’ll discuss ways to prevent and treat high blood pressure in menopause. 

What’s Normal for Blood Pressure During Menopause?

To know if you have high blood pressure, you have to measure it. The general adult guidelines for blood pressure state that a healthy range is less than 120/80 mm Hg. Above that level, there are several increasing levels of cardiovascular disease risk.

• Healthy – Less than 120/80 mm Hg 
• Pre-hypertension – 120/80 to 139/89
• Stage 1 hypertension – 140/90 to 159/99
• Stage 2 hypertension – ≥160/100 or higher
• Hypertensive Crisis – higher than 180 and/or higher than 120 diastolic

How Common is High Blood Pressure During Menopause?

Overall, women have a hypertension incidence of about twenty-eight percent. Women tend to develop high blood pressure about ten years later than men. Menopause is associated with a two-fold increase in the risk of hypertension. In fact, in the United States, experts found that about seventy-five percent of women older than 60 are hypertensive. 

Causes of High Blood Pressure During Menopause

Arterial Stiffness

Estrogen plays a role in vasodilation and vascular relaxation. When estrogen levels drop, your arteries can become less flexible. The rate of arterial stiffness development is not the same for every woman; research demonstrates Black women have higher rates of arterial stiffness and tend to develop it earlier in the menopause transition. Arterial stiffness often leads to higher systolic blood pressure and is an important marker of heart disease.

Changes in the Renin-Angiotensin System (RAS)

The RAS is an important regulator of blood pressure in the body. It involves a complex interplay of hormones and chemical reactions in the kidneys. Estrogen plays a part in this system, and when estrogen levels drop, the RAS is affected and has a harder time down-regulating blood pressure.

Salt Sensitivity

You might find yourself surprisingly sensitive to salt as you go through menopause.  This is another change low estrogen levels can bring to the RAS in the kidneys. Even if you’ve never experienced blood pressure elevation with salt intake before, you may once you’re in menopause.

Weight Gain

Menopause itself is not the cause of weight gain. Aging and other symptoms like sleep disturbance are more to blame, but menopause does cause a redistribution of weight around the midsection. It’s important to be aware of the increased risk of developing high blood pressure with weight gain and increased belly fat. 

Poor Sleep Quality

One common symptom of menopause is insomnia. Poor sleep negatively impacts the body and can worsen your risk of high blood pressure. Interrupted sleep is a stressor that can increase cortisol levels which, in turn, can increase the risk of developing hypertension. High cortisol levels also increase the risk of gaining excess weight, another known risk factor for hypertension. 

Atherosclerosis

It is not uncommon for people in the menopause transition to experience high cholesterol levels, often for the first time in their lives. Elevated cholesterol, along with menopause-related blood vessel rigidity, may increase the risk of plaque buildup. This is known as atherosclerosis, or fatty deposits on the walls of your blood vessels. When atherosclerosis contributes to blood vessel narrowing, it can cause high blood pressure.

Do Menopause Symptoms Cause High Blood Pressure? 

Indirectly, menopause symptoms do affect your blood pressure. Hot flashes and night sweats often cause nighttime wakefulness, leading to interrupted sleep and higher cortisol levels. Menopause can also increase anxiety levels.  The more stress you experience, the likelier you are to have elevated cortisol. High cortisol can lead to weight gain and, ultimately, higher blood pressure. 

Sleep disturbance, fatigue, and depression made worse by menopause might make you less likely to be physically active, and you’ll be more prone to put on weight. Losing muscle mass due to aging and/or inactivity can slow your metabolism during menopause, so even if you’ve made no changes to your diet, you might see the pounds creep up. The more weight you gain, the greater your risk of experiencing hypertension.  

Does Hormone Therapy Increase the Risk of High Blood Pressure?

You might expect adding estrogen back into your body would help protect your cardiovascular health. But experts have not come to a definitive conclusion about the role of hormone therapy in the development of high blood pressure. In fact, for many years, doctors would not prescribe hormone therapy to patients with preexisting hypertension, believing it would worsen their cardiovascular risk, but that is no longer the case. 

The question about hormone therapy and hypertension is a complicated one. Some factors to consider are when hormone therapy is started, what kind of hormones are used, and how the hormone therapy is delivered. 

Early administration of hormone therapy is more likely to be protective of cardiovascular health when compared to late administration. Transdermal patches and topical creams have a higher rate of protection than oral hormone therapy. It’s also important to consider what type of hormones are being used.

Research is still inconclusive about whether or not prolonged use of hormone therapy can lead to cardiovascular disease. Most experts agree that if you begin hormone therapy early in menopause without any previous history of cardiovascular disease, your risk is low. You’ll need to conduct a risk-benefit analysis with your care provider to determine if hormone therapy makes sense for you. In the Midday app, you can use a Mayo Clinic-developed tool to learn about your eligibility for hormone therapy and the risks and benefits.

Signs of High Blood Pressure

High blood pressure is known to be a “silent” disease because it usually doesn’t have any noticeable symptoms. If you experience symptoms, you might not immediately associate them with high blood pressure. Below are some symptoms you might experience with hypertension, especially when blood pressure is extremely high.

• Headache
• Shortness of Breath
• Nosebleed
• Feeling lightheaded
• Blurry vision 

Preventing and Managing High Blood Pressure During Menopause

It’s possible to lower and maintain a healthy blood pressure level through lifestyle changes. Doctors stress

Exercise

Physical activity is an essential part of maintaining cardiovascular wellness and a healthy weight. Building muscle will also help mitigate a slowing down of your metabolism and help you keep the pounds off. 

Stress Management

Managing stress is another critical element of cardiovascular disease risk management. Stress management can be different for every person: meditation, working out, yoga, journaling, or therapy are just a few options. Do what works for you to help you feel more in control of the stressors in your life. 

Quit Smoking

Smokers of tobacco and nicotine products are more likely to develop high blood pressure and cardiovascular disease. Talk to your healthcare provider about the options available to help you quit.

Sleep Hygiene

Sleep should not be a side note in your health journey. A good night’s rest is crucial to staying physically and mentally healthy. Go to bed at the same time every night. Turn off screens an hour or two before bed. Avoid hot flash triggers like alcohol, heavy meals, stress, and caffeine. Make sure your bedroom is cool and dark.

Hormone Therapy

Hormone therapy is not considered an appropriate medication for treating cardiovascular issues, but it can help manage menopause symptoms like hot flashes. Minimizing or eliminating hot flashes can go a long way to improving your quality of life and sleep. It can also help improve your energy level, thus making engaging in physical activity a more attainable goal.

Get Smart With Your Diet

Ditch the diet and opt for heart-healthy foods. You’ll have an easier time with weight management and energy. Be moderate with salt so you can avoid blood pressure fluctuations caused by sodium ingestion. The Mediterranean diet – considered the most heart-healthy way of eating – is a good place to start.   

Blood Pressure Medication

Lifestyle strategies like those mentioned above can be highly effective in lowering blood pressure. You can also talk to your healthcare provider about whether or not an antihypertensive medication might be a good choice for you.

Healthy Heart, Healthy You

Menopause does increase your risk of developing high blood pressure, but knowing that you’re at risk is half the battle. With this knowledge, you can make choices early in your menopause journey to help protect your cardiovascular health over the long term.    

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.