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High blood pressure tends to affect women more after they go through menopause.
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Recent research explores how estrogen influences this increased risk.
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Experts share their insights on the benefits and risks associated with estrogen hormone replacement therapy (HRT).
Have you heard that high blood pressure, or hypertension, tends to impact women following menopause? It’s not just another quirky symptom of menopause—it’s significant, considering that heart disease is the leading cause of death for women in the U.S. Researchers are examining the link between menopause and hypertension, but there’s still much to uncover. One key player seems to be low estrogen levels and, eventually, the absence of this hormone.
Among the experts in the field are Dr. Sheryl Ross, an ob/gyn at Providence Saint John’s Health Center in Santa Monica, and Dr. Cheng-Han Chen, a cardiologist who leads the Structural Heart Program at MemorialCare Saddleback Medical Center in California.
Menopause marks a decline in estrogen production, which is vital for many bodily functions, including maintaining healthy blood circulation. “Estrogen helps keep blood vessels elastic, lowers LDL or ‘bad’ cholesterol, and boosts HDL or ‘good’ cholesterol,” explains Dr. Ross. “When you lose these heart-related benefits during menopause, the risk of cardiovascular issues rises for women.”
A new study has delved deeper into how estrogen affects various physiological and hormonal pathways, particularly how these change with menopause and might influence heart health. Below, Dr. Ross and a cardiologist discuss their interpretations of the findings.
What were the study’s findings?
This research, featured in Mathematical Biosciences, utilized a computer model to simulate how blood pressure is regulated in post-menopausal women. It found that as women age, the chances of developing hypertension increase, with estrogen appearing to play a role.
The model also suggested that certain blood pressure medications, particularly angiotensin receptor blockers, might be more effective for hypertensive women as their estrogen levels decrease. While researchers didn’t directly state how supplemental estrogen via hormone replacement therapy might help, experts see potential benefits.
“Estrogen positively affects nearly every organ system,” says Dr. Ross. “This study reinforces estrogen’s protective role in the vascular system and its influence on blood pressure and cardiovascular health before and after menopause.”
She adds, “Estrogen therapy can restore some benefits like vessel elasticity and dilation, lower LDL levels, and raise HDL levels, all of which are good for heart health. It’s advisable to start estrogen therapy as you approach menopause for the best cardiovascular outcomes.” Dr. Chen also notes that estrogen can help decrease inflammation in the body.
However, Dr. Ross points out that many factors contribute to the risk of cardiovascular disease, including lifestyle, genetics, and family history. While HRT is an important consideration, more research is needed to see if estrogen could serve as a comprehensive treatment for hypertension in menopausal women.
Currently, Dr. Chen mentions that the evidence regarding HRT’s effectiveness is mixed, and it largely depends on the specific formulation used. “Some studies indicate that transdermal estrogen may help manage blood pressure in post-menopausal women, but oral estrogen might actually raise the risk of developing high blood pressure,” he observes.
What is estrogen HRT?
HRT is primarily prescribed through creams or oral medications to manage difficult menopause symptoms like hot flashes, sleep issues, and vaginal dryness. However, it might offer additional benefits, particularly regarding heart health.
“Secondary benefits of HRT, especially when taken in the first decade of menopause, include improved metabolic health, better regulation of insulin, maintenance of body weight, and reduced type 2 diabetes risk,” Dr. Ross notes. “These advantages support hormonal balance, cardiovascular, and metabolic health.”
The bottom line
“All women experiencing menopause or post-menopause should discuss the pros and cons of HRT with their healthcare providers, especially those at risk for heart disease,” advises Dr. Ross. “The secondary benefits regarding heart health are certainly important.”
She emphasizes, “Taking HRT alongside blood pressure medications might have negative interactions, depending on whether someone is in perimenopause or menopause. Since both types of treatments work to enhance blood flow, it’s crucial to have these conversations with your healthcare team to determine if adjustments are necessary.”
