Advertisement

Hypertension across a Woman's lifespan

      Highlights

      • Hypertension is a leading risk factor for cardiovascular disease in women.
      • Sex-specific factors, such as polycystic ovary syndrome, hypertension in pregnancy and menopause, modulate the risk of hypertension across the lifespan.
      • By age 75, the prevalence of hypertens ion in women is higher than in men.

      Abstract

      Hypertension is a leading risk factor for cardiovascular disease in women. Both traditional and sex-specific risk modifiers occurring from menarche to pregnancy to menopause modulate the risk of hypertension and adverse cardiovascular events. This review provides a narrative summary of risk and treatment of hypertension in women across the lifespan, from adolescence to the post-menopausal period, where each period represents a potential window for risk assessment, diagnosis, and appropriate treatment. Management of hypertension throughout a woman's life must be included in a holistic cardiovascular prevention approach for women in order to prevent future cardiovascular complications.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vogel B.
        • Acevedo M.
        • Appelman Y.
        • Bairey Merz C.N.
        • Chieffo A.
        • Figtree G.A.
        • et al.
        The lancet women and cardiovascular disease commission: reducing the global burden by 2030.
        Lancet. 2021; 397: 2385-2438
        • Ahmad A.
        • Oparil S.
        Hypertension in women: recent advances and lingering questions.
        Hypertension. 2017; 70: 19-26
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952
        • Newson L.
        Menopause and cardiovascular disease.
        Post Reprod. Health. 2018; 24: 44-49
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • Casey Jr., D.E.
        • Collins K.J.
        • Dennison Himmelfarb C.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        J. Am. Coll. Cardiol. 2018; 71: 2199-2269
        • Williams B.
        • Mancia G.
        • Spiering W.
        • Agabiti Rosei E.
        • Azizi M.
        • Burnier M.
        • et al.
        2018 ESC/ESH guidelines for the management of arterial hypertension.
        Eur. Heart J. 2018; 39: 3021-3104
        • Gerdts E.
        • de Simone G.
        Hypertension in women: should there be a sex-specific threshold?.
        Eur. Cardiol. 2021; 16e38
        • Wang X.
        • Hao G.
        • Chen L.
        • Yang Y.
        • Zhou H.
        • Kang Y.
        • et al.
        Hypertension-mediated organ damage and established cardiovascular disease in patients with hypertension: the China hypertension survey, 2012–2015.
        J. Hum. Hypertens. 2021;
        • Gerdts E.
        • Oikarinen L.
        • Palmieri V.
        • Otterstad J.E.
        • Wachtell K.
        • Boman K.
        • et al.
        Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the losartan intervention for endpoint reduction in hypertension (LIFE) study.
        Hypertension. 2002; 39: 739-743
        • de Simone G.
        • Devereux R.B.
        • Izzo R.
        • Girfoglio D.
        • Lee E.T.
        • Howard B.V.
        • et al.
        Lack of reduction of left ventricular mass in treated hypertension: the strong heart study.
        J. Am. Heart Assoc. 2013; 2e000144
        • Regnault V.
        • Thomas F.
        • Safar M.E.
        • Osborne-Pellegrin M.
        • Khalil R.A.
        • Pannier B.
        • et al.
        Sex difference in cardiovascular risk: role of pulse pressure amplification.
        J. Am. Coll. Cardiol. 2012; 59: 1771-1777
        • Gerdts E.
        • Okin P.M.
        • de Simone G.
        • Cramariuc D.
        • Wachtell K.
        • Boman K.
        • et al.
        Gender differences in left ventricular structure and function during antihypertensive treatment: the losartan intervention for endpoint reduction in hypertension study.
        Hypertension. 2008; 51: 1109-1114
        • Tadic M.
        • Cuspidi C.
        • Grassi G.
        • Ivanovic B.
        Gender-specific therapeutic approach in arterial hypertension - challenges ahead.
        Pharmacol. Res. 2019; 141: 181-188
        • Albrektsen G.
        • Heuch I.
        • Lochen M.L.
        • Thelle D.S.
        • Wilsgaard T.
        • Njolstad I.
        • et al.
        Risk of incident myocardial infarction by gender: interactions with serum lipids, blood pressure and smoking. The Tromso study 1979–2012.
        Atherosclerosis. 2017; 261: 52-59
        • Millett E.R.C.
        • Peters S.A.E.
        • Woodward M.
        Sex differences in risk factors for myocardial infarction: cohort study of UK biobank participants.
        BMJ. 2018; 363k4247
        • Kringeland E.
        • Tell G.S.
        • Midtbo H.
        • Haugsgjerd T.R.
        • Igland J.
        • Gerdts E.
        Factors associated with increase in blood pressure and incident hypertension in early midlife: the Hordaland Health Study.
        Blood Press. 2020; 29: 267-275
        • Wright Jr., J.T.
        • Williamson J.D.
        • Whelton P.K.
        • Snyder J.K.
        • Sink K.M.
        • et al.
        • Group SR
        A randomized trial of intensive versus standard blood-pressure control.
        N. Engl. J. Med. 2015; 373: 2103-2116
        • Wenger N.K.
        • Arnold A.
        • Bairey Merz C.N.
        • Cooper-DeHoff R.M.
        • Ferdinand K.C.
        • Fleg J.L.
        • et al.
        Hypertension across a woman's life cycle.
        J. Am. Coll. Cardiol. 2018; 71: 1797-1813
        • Riley M.
        • Hernandez A.K.
        • Kuznia A.L.
        High blood pressure in children and adolescents.
        Am. Fam. Phys. 2018; 98: 486-494
        • Green R.
        • Gu X.
        • Kline-Rogers E.
        • Froehlich J.
        • Mace P.
        • Gray B.
        • et al.
        Differences between the pediatric and adult presentation of fibromuscular dysplasia: results from the US registry.
        Pediatr. Nephrol. 2016; 31: 641-650
        • Mulvagh S.L.
        • Mullen K.A.
        • Nerenberg K.A.
        • Kirkham A.A.
        • Green C.R.
        • Dhukai A.R.
        • et al.
        The Canadian Women's Heart Health Alliance Atlas on the epidemiology, diagnosis, and management of cardiovascular disease in women - chapter 4: sex- and gender-unique disparities: CVD across the lifespan of a woman.
        CJC Open. 2022; 4: 115-132
        • Cho L.
        • Davis M.
        • Elgendy I.
        • Epps K.
        • Lindley K.J.
        • Mehta P.K.
        • et al.
        Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review.
        J. Am. Coll. Cardiol. 2020; 75: 2602-2618
        • Amiri M.
        • Ramezani Tehrani F.
        • Behboudi-Gandevani S.
        • Bidhendi-Yarandi R.
        • Carmina E.
        Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression.
        Reprod. Biol. Endocrinol. 2020; 18: 23
        • Oikonomou P.
        • Tsonis O.
        • Paxinos A.
        • Gkrozou F.
        • Korantzopoulos P.
        • Paschopoulos M.
        Preeclampsia and long-term coronary artery disease: how to minimize the odds?.
        Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 255: 253-258
        • Ives C.W.
        • Sinkey R.
        • Rajapreyar I.
        • Tita A.T.N.
        • Oparil S.
        Preeclampsia-pathophysiology and clinical presentations: JACC state-of-the-art review.
        J. Am. Coll. Cardiol. 2020; 76: 1690-1702
        • Gestational Hypertension and Preeclampsia
        ACOG practice bulletin, number 222.
        Obstet. Gynecol. 2020; 135: e237-e260
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • Casey Jr., D.E.
        • Collins K.J.
        • Dennison Himmelfarb C.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and Management of High Blood Pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        Circulation. 2018; 138: e426-e483
        • Tita A.T.
        • Szychowski J.M.
        • Boggess K.
        • Dugoff L.
        • Sibai B.
        • Lawrence K.
        • et al.
        Treatment for mild chronic hypertension during pregnancy.
        N. Engl. J. Med. 2022; 386: 1781-1792
        • Magee L.A.
        • Singer J.
        • von Dadelszen P.
        • Group CS
        Less-tight versus tight control of hypertension in pregnancy.
        N Engl J Med. 2015; 372: 2367-2368
        • Butalia S.
        • Audibert F.
        • Cote A.M.
        • Firoz T.
        • Logan A.G.
        • Magee L.A.
        • et al.
        Hypertension Canada's 2018 guidelines for the management of hypertension in pregnancy.
        Can. J. Cardiol. 2018; 34: 526-531
        • Rezk M.
        • Emarh M.
        • Masood A.
        • Dawood R.
        • El-Shamy E.
        • Gamal A.
        • et al.
        Methyldopa versus labetalol or no medication for treatment of mild and moderate chronic hypertension during pregnancy: a randomized clinical trial.
        Hypertens. Pregnancy. 2020; 39: 393-398
        • Salama M.
        • Rezk M.
        • Gaber W.
        • Hamza H.
        • Marawan H.
        • Gamal A.
        • et al.
        Methyldopa versus nifedipine or no medication for treatment of chronic hypertension during pregnancy: a multicenter randomized clinical trial.
        Hypertens. Pregnancy. 2019; 17: 54-58
        • Rolnik D.L.
        • Wright D.
        • Poon L.C.
        • O'Gorman N.
        • Syngelaki A.
        • de Paco Matallana C.
        • et al.
        Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia.
        N Engl J Med. 2017; 377: 613-622
        • Chaemsaithong P.
        • Cuenca-Gomez D.
        • Plana M.N.
        • Gil M.M.
        • Poon L.C.
        Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia?.
        Am. J. Obstet. Gynecol. 2020; 222: 437-450
        • Tolcher M.C.
        • Sangi-Haghpeykar H.
        • Mendez-Figueroa H.
        • Aagaard K.M.
        Low-dose aspirin for preeclampsia prevention: efficacy by ethnicity and race.
        Am. J. Obstet. Gynecol. 2020; 2100184
        • Poon L.C.
        • Shennan A.
        • Hyett J.A.
        • Kapur A.
        • Hadar E.
        • Divakar H.
        • et al.
        The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention.
        Int. J. Gynaecol. Obstet. 2019; 145: 1-33
        • Cerdeira A.S.
        • O'Sullivan J.
        • Ohuma E.O.
        • Harrington D.
        • Szafranski P.
        • Black R.
        • et al.
        Randomized interventional study on prediction of Preeclampsia/Eclampsia in women with suspected preeclampsia: INSPIRE.
        Hypertension. 2019; 74: 983-990
        • Behrens I.
        • Basit S.
        • Melbye M.
        • Lykke J.A.
        • Wohlfahrt J.
        • Bundgaard H.
        • et al.
        Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study.
        BMJ. 2017; 358j3078
        • Haugdahl H.S.
        • Sandsaeter H.L.
        • Lysne M.
        • Bjerkeset O.
        • Uhrenfeldt L.
        • Horn J.
        Postpartum lifestyle interventions among women with pre-eclampsia: a scoping review protocol.
        BMJ Open. 2020; 10e035507
        • Pacheco C.
        • Mullen K.A.
        • Coutinho T.
        • Jaffer S.
        • Parry M.
        • HGC Van Spall
        • et al.
        The Canadian Women's Heart Health Alliance Atlas on the epidemiology, diagnosis, and management of cardiovascular disease in women - chapter 5: sex- and gender-unique manifestations of cardiovascular disease.
        CJC Open. 2022; 4: 243-262
        • Park S.
        • Choi N.K.
        Breastfeeding and maternal hypertension.
        Am. J. Hypertens. 2018; 31: 615-621
        • Piepoli M.F.
        • Hoes A.W.
        • Agewall S.
        • Albus C.
        • Brotons C.
        • Catapano A.L.
        • et al.
        2016 European guidelines on cardiovascular disease prevention in clinical practice.
        Rev. Esp. Cardiol. (Engl. Ed.). 2016; 69: 939
        • Pearson G.J.
        • Thanassoulis G.
        • Anderson T.J.
        • Barry A.R.
        • Couture P.
        • Dayan N.
        • et al.
        2021 Canadian cardiovascular society guidelines for the Management of Dyslipidemia for the prevention of cardiovascular disease in adults.
        Can. J. Cardiol. 2021; 37: 1129-1150
        • Graves M.
        • Howse K.
        • Pudwell J.
        • Smith G.N.
        Pregnancy-related cardiovascular risk indicators: primary care approach to postpartum management and prevention of future disease.
        Can. Fam. Physician. 2019; 65: 883-889
        • Ramirez L.A.
        • Sullivan J.C.
        Sex differences in hypertension: where we have been and where we are going.
        Am. J. Hypertens. 2018; 31: 1247-1254
        • Gersh F.L.
        • O'Keefe J.H.
        • Lavie C.J.
        • Henry B.M.
        The renin-angiotensin-aldosterone system in postmenopausal women: the promise of hormone therapy.
        Mayo Clin. Proc. 2021; 96: 3130-3141
        • Hodis H.N.
        • Mack W.J.
        • Henderson V.W.
        • Shoupe D.
        • Budoff M.J.
        • Hwang-Levine J.
        • et al.
        Vascular effects of early versus late postmenopausal treatment with estradiol.
        N. Engl. J. Med. 2016; 374: 1221-1231
        • Miller V.M.
        • Naftolin F.
        • Asthana S.
        • Black D.M.
        • Brinton E.A.
        • Budoff M.J.
        • et al.
        The kronos early estrogen prevention study (KEEPS): what have we learned?.
        Menopause. 2019; 26: 1071-1084
        • The North American Menopause Society
        The 2017 hormone therapy position statement of the North American Menopause Society.
        Menopause. 2017; 24: 728-753
        • Mounier-Vehier C.
        • Madika A.L.
        Post-menopausal hypertension: detecting, treating, accompany, prevent.
        Presse Med. 2019; 48: 1288-1294
        • Silveira J.S.
        • Clapauch R.
        • Souza M.
        • Bouskela E.
        Hot flashes: emerging cardiovascular risk factors in recent and late postmenopause and their association with higher blood pressure.
        Menopause. 2016; 23: 846-855
        • Yoon S.S.
        • Carroll M.D.
        • Fryar C.D.
        Hypertension prevalence and control among adults: United States, 2011–2014.
        NCHS Data Brief. 2015; 220: 1-8
        • Wright Jr., J.T.
        • Whelton P.K.
        • Reboussin D.M.
        A randomized trial of intensive versus standard blood-pressure control.
        N. Engl. J. Med. 2016; 374: 2294
        • Ochoa-Jimenez R.
        • Viquez-Beita K.
        • Daluwatte C.
        • Zusterzeel R.
        Sex differences of patients with systemic hypertension (From the analysis of the systolic blood pressure intervention trial [SPRINT]).
        Am. J. Cardiol. 2018; 122: 985-993
        • Oliveros E.
        • Patel H.
        • Kyung S.
        • Fugar S.
        • Goldberg A.
        • Madan N.
        • et al.
        Hypertension in older adults: assessment, management, and challenges.
        Clin. Cardiol. 2020; 43: 99-107
        • Benetos A.
        • Petrovic M.
        • Strandberg T.
        Hypertension management in older and frail older patients.
        Circ. Res. 2019; 124: 1045-1060
        • Lackland D.T.
        Racial differences in hypertension: implications for high blood pressure management.
        Am. J. Med. Sci. 2014; 348: 135-138
        • Bornstein E.
        • Eliner Y.
        • Chervenak F.A.
        • Grunebaum A.
        Racial disparity in pregnancy risks and complications in the US: temporal changes during 2007–2018.
        J. Clin. Med. 2020; 9
        • Jaffer S.
        • HJA Foulds
        • Parry M.
        • Gonsalves C.A.
        • Pacheco C.
        • Clavel M.A.
        • et al.
        The Canadian Women's Heart Health Alliance ATLAS on the epidemiology, diagnosis, and management of cardiovascular disease in women-chapter 2: scope of the problem.
        CJC Open. 2021; 3: 1-11
        • Tobe S.W.
        • Pylypchuk G.
        • Wentworth J.
        • Kiss A.
        • Szalai J.P.
        • Perkins N.
        • et al.
        Effect of nurse-directed hypertension treatment among first nations people with existing hypertension and diabetes mellitus: the diabetes risk evaluation and microalbuminuria (DREAM 3) randomized controlled trial.
        CMAJ. 2006; 174: 1267-1271
        • Magee L.A.
        • von Dadelszen P.
        State-of-the-art diagnosis and treatment of hypertension in pregnancy.
        Mayo Clin. Proc. 2018; 93: 1664-1677
        • ACOG Practice Bulletin No
        206: use of hormonal contraception in women with coexisting medical conditions.
        Obstet. Gynecol. 2019; 133: e128-e150
        • Hickson S.S.
        • Miles K.L.
        • McDonnell B.J.
        • Yasmin Cockcroft J.R.
        • Wilkinson I.B.
        • et al.
        Use of the oral contraceptive pill is associated with increased large artery stiffness in young women: the ENIGMA study.
        J. Hypertens. 2011; 29: 1155-1159
        • Bolland M.J.
        • Ames R.W.
        • Horne A.M.
        • Orr-Walker B.J.
        • Gamble G.D.
        • Reid I.R.
        The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women.
        Osteoporos. Int. 2007; 18: 479-486
        • Osude N.
        • Durazo-Arvizu R.
        • Markossian T.
        • Liu K.
        • Michos E.D.
        • Rakotz M.
        • et al.
        Age and sex disparities in hypertension control: the multi-ethnic study of atherosclerosis (MESA).
        Am. J. Prev. Cardiol. 2021; 8100230
        • Turnbull F.
        • Woodward M.
        • Neal B.
        • Barzi F.
        • Ninomiya T.
        • Chalmers J.
        • et al.
        Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials.
        Eur. Heart J. 2008; 29: 2669-2680
        • Rydberg D.M.
        • Mejyr S.
        • Loikas D.
        • Schenck-Gustafsson K.
        • von Euler M.
        • Malmstrom R.E.
        Sex differences in spontaneous reports on adverse drug events for common antihypertensive drugs.
        Eur. J. Clin. Pharmacol. 2018; 74: 1165-1173