Hypertension

High Blood Pressure

What is hypertension and why is it important?

Hypertension is a condition in which the blood pressure in the arteries is higher than it should be. It causes damage to the inside of the arteries, resulting in narrowing (atherosclerosis) or bleeding (hemorrhage).

Hypertension is a major cause of heart attacks and the leading cause of strokes in women. It also contributes to the risks of kidney disease, eye disease and dementia.

Blood pressure in women often rises quickly after menopause.

60% of women aged 40-59 years have hypertension
75% of women aged 60+ years have hypertension

More than 1/3 of women with hypertension don’t know they have it as it has no symptoms, unless the level of blood pressure is very high

How is blood pressure measured and diagnosed?

Blood pressure is measured in the artery on the inside of your elbow using a sphygmomanometer (usually an electronic blood pressure measurement device). Normally, two or three measurements are taken because blood pressure levels often fall after the first measurement.

Two pressures are measured

The systolic (the highest pressure)
The diastolic (the lowest pressure)

How high is too high?

The US guidelines for physicians define hypertension as:

Stage 1: a systolic pressure of 130 - 139 millimetres of mercury (mmHg) or a diastolic pressure of 80 – 89 mmHg or more
Stage 2: a systolic of 140mmHg or more or a diastolic of 90 mmHg or more

These definitions are not different for women and men, for younger and older women, or for different ethnicities.

If you have hypertension, you should measure your blood pressure at home several times a week.

Regular home measurement of blood pressure has been shown to result in better blood pressure control

Understanding and Managing Hypertension

Learn about the causes of hypertension, how it might be prevented and what treatments are available

What causes hypertension?

For most women (and men), the main cause of hypertension is being overweight.
Other contributors include:

Too much salt (mainly from table salt, fast foods and snacks)
Too little dietary potassium (mostly from not eating enough fruit and vegetables)

If a close family member (parent, brother or sister) has hypertension, your risk will be increased.

Some causes are unique to women:

High blood pressure during pregnancy increases your risk of developing hypertension later in life by about 2-4 times
Endometriosis increases your risk by about 30%
Fibroids increase your risk by about 50%

In a small proportion of women, additional underlying medical conditions, such as kidney disease or aldosteronism, may be the cause of hypertension

Before perimenopause (usually less than 45 years of age)

Blood pressure usually rises slowly with age

Mainly due to increasing weight

Fibroids and endometriosis increase the risk of blood pressure rising

Hypertension during pregnancy increases the risk of blood pressure rising

Blood pressure should be checked at least every 3-5 years

During perimenopause (usually 45-55 years of age)

Falling levels of hormones (estrogen and progestogen) often cause blood pressure to rise more quickly

Weight tends to rise and body fat tends to move from the hips and thighs to the abdomen, which contributes to the rise in blood pressure

Blood pressure should be measured every year

Menopause

Hormone levels are reduced and body fat continues to move to the abdomen, and body muscle tends to decrease

Blood pressure rises more quickly in women than men

Hypertension develops in a large proportion of women

Blood pressure should be checked regularly

Action Plan

Taking Charge of Your Hypertension

For some women, lifestyle changes can help prevent hypertension and may also lower blood pressure once hypertension is diagnosed.

However, for most women, the most effective approach to managing hypertension and reducing the risks of heart attack, stroke and kidney disease requires a combination of lifestyle changes, regular blood pressure checks and appropriate medication.

Lifestyle Changes

Walk or do other exercise for around 20 minutes per day

Reduce salt by eating less table salt, fast food and salty snacks

Increase potassium by eating more fruit, vegetables and nuts

If you are overweight, try to lose at least 10 lbs

Treatment

Check your blood pressure regularly

In addition to making lifestyle changes, talk to your doctor about drug treatment

All the most commonly used drugs are effective and have few side effects

Treatment with two drugs is recommended

Medication should never be stopped abruptly

Ongoing benefits of treatment

Reductions of 25-50% in your risk of heart disease, stroke and kidney disease

Life-long treatment is usually required unless you make major lifestyle changes

Lifestyle changes and drug treatment together are likely to produce the largest benefits

Questions you might like to ask your doctor or other healthcare professional

Advocate for yourself

Answer a few quick questions about your symptoms and get a personalised cheat sheet to bring to your next appointment - ready to print or save.

Hypertension

Hypertension

How is blood pressure measured and diagnosed?

How high is too high?

Understanding and Managing Hypertension

What causes hypertension?

Before perimenopause (usually less than 45 years of age)

During perimenopause (usually 45-55 years of age)

Menopause

Taking Charge of Your Hypertension

Lifestyle Changes

Treatment

Ongoing benefits of treatment

Questions you might like to ask your doctor or other healthcare professional

Is my blood pressure properly controlled? Is the systolic blood pressure less than 130mmHg and the diastolic less than 80mmHg?+−

Do I have another condition, like diabetes, that would put me at much higher risk of stroke or heart attack and make blood pressure control more important?+−

(If you have hypertension and are not on treatment) Why am I not on antihypertensive treatment?+−

(If you are on two drugs and your blood pressure is not controlled) Why am I not on three drugs as recommended by the guidelines?+−

(If you are overweight and not able to lose weight by diet and exercise) Should I be on a GLP-1 agonist like Ozempic or Zepbound?+−