Saturday, March 30, 2013

Menopause and High Blood Pressure

Blood pressure generally increases after menopause. Some doctors think this increase suggests that the hormonal changes of menopause may play a role in high blood pressure. Others think an increase in body mass index (BMI) in menopausal women may play a greater role than hormonal changes.

Menopause-related hormonal changes can lead to weight gain and make your blood pressure more reactive to salt in your diet — which, in turn, can lead to higher blood pressure. For some women, hormone therapy (HT) for menopause also may contribute to increases in blood pressure.

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General causes for high blood pressure

High blood pressure, also known as hypertension, is caused by several factors including: age, heredity, race, sodium intake, obesity, alcohol, and inactivity.

* Age. As people age, there is an increased likelihood of high blood pressure.

* Heredity. High blood pressure tends to run in families.

* Race. African Americans tend to develop high blood pressure compared to Caucasians.

* Sodium intake. Some people have higher sensitivity to sodium. Consuming foods that are high in sodium cause an increase in blood pressure.

* Obesity. Blood pressure increases as body weight increases.

* Alcohol. Consuming more than one to two glasses of alcoholic beverages a day can increase blood pressure.

* Inactivity. Lack of exercise or leading a sedentary lifestyle can lead to obesity and an increase in blood pressure.              

Hypertension as a key risk factor in menopause

As blood is pumped from your heart through your body, the blood puts force or pressure against the blood vessel (or artery) walls. Your blood pressure is a reading, or measure, of this pressure. When that reading goes above a certain point, it is called high blood pressure, another name for hypertension. When you have high blood pressure, it is partly because your blood vessels become narrower, forcing your heart to pump harder to move blood through your body. These changes cause the blood to press on the vessels walls with greater force.

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High blood pressure is called the "silent killer" because it usually has no signs or symptoms. It is dangerous because it makes the heart work too hard. If not controlled over time, high blood pressure can affect not only your heart and blood vessels but also other organs, making them function not as well as they should. The effects of uncontrolled high blood pressure include:

* Stroke. High blood pressure is the most important risk factor for stroke. High blood pressure can cause a break in a weakened blood vessel in the brain. This can cause bleeding in the brain, which is a stroke. If a blood clot blocks a narrowed blood vessel, it can also cause another type of stroke.

* Impaired vision. Blood vessels in the eye can in time burst or bleed due to high blood pressure. Vision can become blurred or impaired and can result in blindness.

* Kidney damage. The kidneys filter wastes from our bodies. Over time, high blood pressure can narrow and thicken the blood vessels of the kidneys. Thus the kidneys cannot do their job well, and wastes build up in the blood. When kidney failure occurs, medical treatment (dialysis) or a kidney transplant is needed.

* Heart attack. High blood pressure is a major risk factor for heart attack. If the heart cannot get enough oxygen because of narrowed or hardened arteries, chest pain (angina) can occur. If the flow of blood is blocked, a heart attack results.

* Congestive heart failure. High blood pressure is the number one risk factor for congestive heart failure, a serious condition where the heart is not able to pump enough blood to meet the body's needs.

So, hypertension is very most important risk factor that affects women in her postmenopausal years. About 30 to 50% of women develop hypertension (RR >140/90 mmHg) before the age of 60 and the onset of hypertension can cause a variety of symptoms that are often attributed to menopause.

Women's systolic pressure -- the top number in the blood pressure reading and the one that's more closely associated with heart disease risk and stroke in people over age 50 -- increases by about 5 millimeters of mercury (mm Hg) with menopause. A study done between 2001 and 2003 among people over age 60 showed that women had a higher systolic blood pressure than did men in every state in America. According to the report, women tended to think they didn't have high blood pressure when, in fact, they did.

For healthy adults, blood pressure less than 120/80 mm Hg is desirable. Untreated high blood pressure can cause the heart to work too hard. Mild to moderate hypertension may cause complaints such as non-specific chest pain, sleep disturbances, headaches, palpitations, hot flushes, anxiety, depression, tiredness, etc.

Women with a family history of hypertension and women with a history of hypertension in pregnancy are at increased risk to develop hypertension in this age period. Hypertension often clusters with other risk factors such as overweight, elevated insulin resistance, diabetes, and lipid abnormalities. In the Women’s Health Study it was shown in almost 40,000 healthy women (≥45 years) that an elevated blood pressure increases CV risk and that hypertension is a strong predictor for the development of type II diabetes. Even in premenopausal women, hypertension has been shown to be a potent risk factor for the presence of coronary artery disease. Despite the high prevalence of hypertension in middle-aged women, less than half of the patients receive adequate treatment, especially in the older age group when the risk of hypertension-related morbidity and mortality is highest.

Checking blood pressure

Do you know that there are people having high blood pressure only when they visit their health care provider's office? This condition is called white coat hypertension. It is quite easy and convenient to test your blood pressure at the convenience of your home. There are over-the-counter blood pressure measuring devices you can purchase in pharmacies and discount chain stores that you can use at home. These include the blood pressure cuff and a stethoscope and electronic monitors, such as digital readout monitors.

Here are some tips for what you can do to ensure as accurate a blood pressure reading as possible:

* Don't drink coffee or smoke for 30 minutes before the blood pressure check.

* Before your blood pressure is checked, sit still for five minutes with your back supported and your feet flat on the ground. Try to rest your arm on a table at the level of your heart.

* Go to the bathroom prior to the reading. A full bladder can change your blood pressure reading.

* Get two readings, taken at least two minutes apart, and average the results.

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Controlling blood pressure

To control your blood pressure both before and after menopause, focus on a healthy lifestyle:

1. Get regular physical exercise. Exercise helps lower blood pressure because it makes the heart stronger. With greater strength, the heart can pump more blood with less effort. Being physically active for 30 to 60 minutes most days of the week can lower blood pressure by 4 to 9 mm Hg.

2. Follow a healthy eating plan. A healthy diet consists mostly of fruits, vegetables, whole grains and low-fat or fat-free dairy products. Limit consumption of red meat, processed foods and sweets. Several studies have shown that those who follow the Dietary Approaches to Stop Hypertension (DASH) eating plan, a healthy diet similar to what's described here, may reduce blood pressure by up to 14 mm Hg.

3. Reduce dietary sodium. Salt (sodium) increases blood pressure in most people with high blood pressure and in about 25 percent of people with normal blood pressure. The recommended daily sodium intake is 1,500 to 2,400 milligrams; lower is even better.

4. Limit alcohol intake. In small amounts, alcohol can help prevent heart attacks and coronary artery disease. But that protective effect is lost when women regularly drink more than one drink a day. Above that amount, alcohol can raise blood pressure by several points and can interfere with blood pressure medications.

5. Achieve a healthy weight. Being thin isn't essential. But for those who are overweight, losing as little as 5 percent to 10 percent of body weight can lower blood pressure by several points. With less body mass to nourish, the heart doesn't have to pump as hard and the pressure on the arteries decreases.

6.  If you still smoke, stop!

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 Latest research

While there is a definite causal relationship between ageing and tendency for higher blood pressure, the two new research studies have confirmed that there are no reasons to believe that menopause itself causes high blood pressure, and the hormonal changes impact on the high pressure development risk yet to be validated.

A study led by Dr Casiglia of University of Padova, Italy analyzed over 9,000 women aged 18 to 70 years. The researchers found that a higher risk of hypertension in menopausal women was due to their higher age not due to the fact that they were menopausal. The researchers concluded, “Conclusion: The cardiovascular effects usually attributed to menopause seem to be a mere consequence of the older age of menopausal women.”

A study led by Dr Cifkova from Prague, Czech Republic analyzed 900 women aged 45-54 years as they went through menopause. Researchers found there was no relationship between blood pressure and menopausal status - being premenopausal, going through menopause, or being postmenopausal. Menopausal status had no effect on the risk of high blood pressure. However, they found the main factor to increase blood pressure was an increase in BMI (Body Mass Index) or body fatness.

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