Menopause and High Blood Pressure – Is There a Connection?

I came across a startling fact in this month’s Berkeley Wellness Letter. Apparently, hypertension drugs have replaced hormone therapy as the No. 1 medication for women age 45-64.  Another article, this one in The Mayo Clinic’s Women’s HealthSource, about blood pressure changes in women as they age, stated that womens’ systolic pressure – that’s the top number in a BP reading and the one that’s more closely associated with heart disease risk and stroke in people over age 50- increases by about 5 millimeters of mercury with menopause.  So, is there a correlation between rising blood pressure and declining estrogen levels?

I asked Dr. Sharonne Hayes, Director of the Women’s Heart Clinic at the Mayo Clinic (pictured below). Here is her response:

Dr. Sharrone HayesDr. Hayes:  Systolic blood pressure is lower in women than in men in early adulthood, but the rate of increase in women age 50-60 is steeper than it is for men.  This results in blood pressures in women over age 60 that are as high or higher than those in men.

Whether this steeper BP rise in women is due solely to menopause and loss of estrogen, or to other factors such as weight gain, decreased physical activity or other lifestyle changes,  is not entirely clear. There is evidence that all these factors contribute to hypertension.

For instance, loss of estrogen is associated with loss of elasticity of the arteries and arterial stiffness can contribute to rising blood pressure. On the other hand, the 50′s are when some women start to develop orthopedic and other issues that can lead to decreased physical activity and weight gain and both of these factors contribute to elevated blood pressure.

Wendy:  The HealthSource article offered five ways to keep blood pressure in check – basically diet and exercise. However, if there is a correlation between rising blood pressure and estrogen loss, can hormone replacement help as a diuretic or other hypertension drug would?

Dr. Hayes:  We emphasize diet and exercise because they actually work, even if they are often hard for a women to implement. For example, following the DASH eating plan not only can reduce blood pressure as much as taking an anti-hypertensive, it can prevent hypertension from developing. The DASH eating plan is even more effective in women than men and in African Americans than whites.

Blood pressure does not appear to be simply due to estrogen lack although vascular function clearly changes at menopause.  For instance, BP does not abruptly rise with surgical menopause. Also, studies have shown that BP rises at the same rate in women on hormone therapy as those who do not take it.  Other studies have shown that BP is not reduced by treatment with hormone therapy.  For now, hypertension should not be a major factor in the decision to take or not take HT.


Here, according to the Mayo Clinic, are five steps you can take to keep your blood pressure in check:

  1. Get regular exercise – being physically active for 30 to 60 minutes most days of the week can lower blood pressure by 4 to 9 mm Hg.
  2. Follow a healthy eating plan- Limit consumption of red meat, processed foods and sweets.
  3. Reduce dietary sodium- Salt (sodium) increases blood pressure in most people with high blood pressure and in about 25 percent of people with normal blood pressure.
  4. Limit alcohol intake - In small amounts, alcohol can help prevent heart attacks and coronary artery disease. But that protective effect is lost when women regularly drink more than one drink a day. Above that amount, alcohol can raise blood pressure by several points and can interfere with BP medications.
  5. Achieve a healthy weight- For those who are overweight, losing as little as five percent to 10 percent of body weight can lower blood pressure by several points. With less body mass to nourish, the heart doesn’t have to pump as hard and the pressure on the arteries decreases.

If you want to know more about high blood pressure-  what causes it and what you can do about it – I recommend the Mayo Clinic High Blood Pressure DVD. It’s informative and features insights and advice from Mayo Clinic physicians along with simple health tips.