New data challenge long-held assumption about high blood pressure in women
Pulse pressure, the difference between the top and bottom numbers in a blood pressure reading, is lower in women than men early on, but significantly higher for women than men after middle age.
This is typically believed to be a byproduct of menopause, but new research published in Hypertension suggests this difference is sparked years before menopause even begins.[1]
The study’s authors explored data from more than 6,500 women and more than 3,000 men who participated in the Framingham Heart Study. Participants were assessed three separate times during a 14-year period of time. Overall, the authors found that pulse pressure reached its lowest point and then started to rise approximately a decade earlier in women than in men;. While it happens when women are in their late 30s—well before menopause typically begins—it happens when men are in their late 40s. The timing was the same for women whether their menopause began early, late or at the typical time.
By the time patients are approximately 60 years old, the researchers noted, women were consistently linked to a higher pulse pressure than men.
“To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife,” senior author Gary F. Mitchell, MD, a veteran Framingham Heart Study investigator and the president of Cardiovascular Engineering, said in a statement.
Pulse pressure is directly related to the stiffening of the walls of the aorta. The study’s authors emphasized that clinicians should keep these sex-specific differences between men and women in mind when managing patients.
“Healthcare professionals should definitely consider pulse pressure in middle-aged and older patients–especially women–with high blood pressure,” Mitchell said. “Because women’s overall heart disease risk is lower, they are often told that a blood pressure that is ‘borderline’—for example an upper number of 130 mm Hg—can just be watched. However, women and their doctors should sound the alarm if pulse pressure is higher than 60 mm Hg (such as 130/70 mm Hg) and track it over time to see if pulse pressure is rising.”
The group also noted patients with a higher pulse pressure may be less likely to respond to certain hypertension treatments. Gaining insights about pulse pressure and aortic stiffness may help unlock certain treatment strategies that would have not been considered otherwise.
Menopause remains an essential part of any health evaluation
Of course, menopause remains a major milestone in every woman’s life in terms of cardiovascular risk. Samar R. El Khoudary, PhD, MPH, a researcher with Virginia Commonwealth University, said in the same statement that care teams should still be thinking about menopause when considering a patient’s long-term health. In addition, she noted, pulse pressure changes may still be “accelerated” when menopause begins.
“We shouldn’t wait until menopause to start thinking about cardiovascular health,” she said. “By the time a woman reaches her final menstrual period, vascular changes may already have been underway for years. Midlife is an opportunity to identify cardiovascular risk early and intervene before disease develops.”
Click here and here for additional context about the impact menopause can have on a woman’s cardiovascular health.
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.