Increases in blood pressure and cardiovascular disease risk occurring in women after menopause do not result from menopause itself, according to two new studies reported in the October Journal of Hypertension. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

While the two studies offer differing explanations for the postmenopausal increase in blood pressure, they lend new insights into how women’s cardiovascular risk changes after menopause—and the best approaches to managing those risks.

Study Assesses Impact of Body Mass Index on Blood Pressure in Menopause
In a study led by Dr. Renata Cifkova of the Institute for Clinical and Experimental Medicine in Prague, Czech Republic, detailed blood pressure measurements were made in about 900 women aged 45 to 54. The women were classified as being premenopausal, late in the menopausal transition, or postmenopausal. The relationship between stage of menopause and blood pressure was analyzed, taking into account a wide range of other factors.

After adjustment for the effects of age, there was no relationship between blood pressure and menopausal status—blood pressure levels were similar for women who were premenopausal, going through menopause, or postmenopausal. Menopausal status also had no effect on the risk of high blood pressure (hypertension).

On further analysis, the factor most strongly related to blood pressure was the women’s body mass index (BMI)—a standard measure of body fatness, which tends to increase with age. “The rise in blood pressure after the menopause appeared to be due to increased BMI, rather than to ovarian failure per se,” reports Dr. Cifkova and colleagues.

Second Study Evaluates Blood Pressure Values in Women From 18 to 70
A second study, led by Dr. Edoardo Casiglia of University of Padova, Italy, included more than 9,000 women ranging in age from 18 to 70. Absolute blood pressure levels were higher for menopausal women than for fertile (premenopausal) women. Other potential cardiovascular risk factors were also greater in menopausal women.

However, as in the Czech study, the relationship between menopause and blood pressure was no longer significant after adjustment for age. Apparent menopause-related differences in several other risk factors—including BMI—also disappeared after adjustment for age.

On long-term follow-up, menopausal women had greater increases in blood pressure and cardiovascular disease risk, compared to fertile women. Again, however, the differences were no longer present after adjustment for age. “Menopausal women seem to have higher BP values and worse risk profile than the fertile ones, but this is simply due to their older age,” according to the researchers.

Reduced Levels of Oestrogen Do Not Increase Cardiovascular Risk
Increases in blood pressure likely contribute to the increased risk of cardiovascular disease after menopause. It has sometimes assumed that the rise in blood pressure results from the drop in levels of the hormone oestrogen after menopause, and thus that menopause “makes women similar to men” in terms of cardiovascular risk.

The two new studies agree that menopause itself does not cause increased blood pressure. The Czech researchers think that increases in body weight in older women are the most important factor. If so, then weight loss and other lifestyle changes in might help to prevent increases in blood pressure —and thus reduce cardiovascular risk—in women after menopause.

The Italian researchers believe that older age is the key contributor to increases in blood pressure and other cardiovascular risk factors after menopause. In any case, the postmenopausal rise in blood pressure doesn’t appear to result from menopause-related drops in oestrogen level. This may help to explain why studies of hormone replacement therapy to prevent cardiovascular disease didn’t work, “simply put, the target of therapy was wrong,” Dr. Casiglia and colleagues conclude.

About Journal of Hypertension
Journal of Hypertension consistently attracts the most important and highly innovative papers from the current research; our commitment to rapid publication ensures that these are published in the fastest time possible. In addition to primary papers from world-renowned experts, the Journal contains authoritative reviews that summarize and evaluate the most significant recent developments. Also included are special reports, original short papers containing innovative and time-sensitive information. Journal of Hypertension is official journal of the International Society of Hypertension and the European Society of Hypertension.

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Source: Wolters Kluwer Health: Lippincott Williams & Wilkins