The overlooked link between menopause and women’s blood pressure risk

As the world observes World Hypertension Day on May 17, data shows that South African women face disproportionally high rates of hypertension. Leading experts are calling for more gender-sensitive approaches to heart health, focusing not only on treatment, but also on prevention and holistic care.

While men typically experience a gradual rise in blood pressure from their 20s, women face unique risk factors. These include gestational hypertension, high blood pressure during pregnancy and more significantly around menopause, when hormonal changes affect

how blood vessels function.

“Even in women with no family history of high blood pressure, experiencing it during pregnancy significantly increases their risk later in life,” says Ingrid Singels, Marketing Manager of Pharma Dynamics’ Scientific Division.

“After menopause, the drop in estrogen reduces nitric oxide, which normally helps keep blood vessels relaxed and leads to increased blood pressure. This is why postmenopausal women often display higher systolic blood pressure than men of the same age, along with stiffer arteries and increased reninangiotensin system activity contributing to this shift.”

This is backed by a review in the Netherlands Heart Journal, which confirms that 30-50% of women develop hypertension before age 60, with the risk increasing due to central fat distribution, diabetes and elevated insulin resistance during the menopausal transition.

In South Africa, the challenge is even more acute. Hypertension in women increased from 31% in 1998 to 48% in 2016, according to national health data. This increase has been driven in part by unhealthy dietary habits, such as the high consumption of sugary drinks, processed foods and salt-rich meals, which have contributed to widespread obesity.

A 2020 study of South African adults found that women with higher waist-to-hip ratios were 1.75 times more likely to have hypertension and those with diabetes were three times more likely to be hypertensive.

Furthermore, socioeconomic disparities lead to unequal access to healthcare, nutritious food and consistent follow-up care. Public health experts argue this makes targeted interventions a must.

Singels remarks that women not only face an increased risk, but also react differently to hypertension medications.

A 2022 study from the University of Chicago found that women experience nearly twice the number of adverse drug reactions as men, often due to sex differences in drug metabolism and absorption. Diuretics may increase the risk of electrolyte imbalances, while ACE inhibitors often trigger a persistent cough in female patients.

“Many antihypertensive drugs were tested predominantly on men and therefore might not be fully optimised for women’s physiology. This makes lifestyle changes, such as reducing salt intake, healthy eating, regular exercise, stress management, quitting smoking, limiting

alcohol consumption and ensuring adequate sleep essential components of hypertension management in women,” says Singels.

“It’s also crucial for women to engage in regular screenings, including blood pressure and cholesterol monitoring. Your healthcare practitioner should also check for hormonal fluctuations, which can affect blood pressure.”

As awareness grows around the unique ways hypertension affects women, especially during and after menopause, there is a pressing need for more inclusive research, education and care models. By prioritising early detection, gender-sensitive treatment plans and sustainable lifestyle changes, SA healthcare can take meaningful strides in reducing the burden of hypertension among women.