Hypertension Along Women’s Life Course

Hypertension is the most common risk factor for cardiovascular diseases (CVD) and mortality in women. In young adults, women have a lower blood pressure (BP) than men, and hypertension is uncommon. Hypertensive pregnancy complications and several fertility related factors are associated with development of hypertension in young women. From the third decade onwards BP increases more steeply in women than men. Older women have a higher BP than men at similar age, and hypertension is found in >60%. Obesity, autoimmune disorders and reduced renal function are common co-morbidities in these women. Menopausal transition results in clustering of metabolic risk factors and a transformation from low to high CVD risk in many women. Salt sensitive hypertension is particularly common in post-menopausal women. The risk for CVD increases at a lower BP level in women than in men. Although the effect of antihypertensive treatment on reduction of CVD was the same in women as in men in a meta-analysis of clinical trials, adverse antihypertensive drug effects are more prevalent among women, and BP control declines with aging in women. Taken together, women should regularly measure their BP from age 40 years onward to avoid delayed diagnosis of hypertension. Women with hypertensive pregnancy complications should thereafter measure their BP annually. Future research should document whether lower BP threshold values and treatment targets may further improve CVD prevention in women.