Menopause and high blood pressure: What's the connection?

Does menopause affect blood pressure?

- Susan / New York

Mayo Clinic breast-health specialist Sandhya Pruthi, M.D., and colleagues answer select questions from readers.

Answer

Yes. Blood pressure increases after menopause and so does the risk of high blood pressure.

There has been some debate about whether these changes in blood pressure are truly due to menopause or are a consequence of age and weight gain. But after taking these factors into account, researchers have found that postmenopausal women are at higher risk of high blood pressure than are premenopausal women. This suggests that estrogen may play a protective role in blood pressure.

Before menopause, women have slightly lower diastolic pressure and systolic pressure than men do. After menopause, systolic pressure in women increases by about 5 millimeters of mercury (mm Hg).

Menopause-related increases in blood pressure can be attributed in part to increased salt sensitivity and weight gain that are in turn associated with hormone changes during menopause. Hormone replacement therapy (HRT) for menopause also may contribute to increases in blood pressure. Women older than age 50 who take HRT may have a small increase — usually 1 to 2 mm Hg — in systolic blood pressure. These women are also 25 percent more likely to have high blood pressure than are women who don't take HRT.

You can take steps to control high blood pressure after menopause. Lifestyle changes can help avoid, delay or reduce the need for medications. These include:

Reducing sodium in your diet
Increasing physical activity
Achieving and maintaining a healthy weight on the DASH eating plan
Limiting or avoiding alcohol
Avoiding tobacco use

However, sometimes lifestyle changes aren't enough. In such cases, medications such as diuretics are very effective in reducing blood pressure. In addition, a European study published in June 2006 in the journal Hypertension suggests that a new hormone therapy — which combines drospirenone (DRSP) and 17-beta-estradiol — may reduce blood pressure in postmenopausal women who have high blood pressure. However, the dosages used in the study are not yet available in the United States.