Key takeaways:

• Increased pulse pressure among older women was not linked to menopausal hormone changes.
• High pulse pressure can be caused by aortic stiffness and is linked to strain on the heart.

Increased pulse pressure among older women, previously hypothesized to be menopause-related, may be an independent risk for cardiovascular disease among older women, researchers reported.

Pulse pressure is defined as the difference between systolic and diastolic BP and may serve as a predictor of aortic stiffness and risk for heart disease among older women, whose pulse pressure is on average higher than men, according to data published in Hypertension.

Increased pulse pressure among older women was not linked to menopausal hormone changes. Image: Adobe Stock

“Many people believe that the change in pulse pressure is linked to the hormonal shifts caused by menopause. Here, we are evaluating whether the timing of this change, from falling to rising pulse pressure, is connected to menopause timing in a long-term study,” Gary F. Mitchell, MD, investigator with the Framingham Heart Study and president of Cardiovascular Engineering Inc. in Needham, Massachusetts, said in a press release. “To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife.”

The researchers used data from 6,211 participants in the Framingham Heart Study–Cohort (52% men) to better understand the relationship between age at menopause and pressure pulsatility. Women included in the analysis were stratified based on age at last menstrual cycle: persistently premenopausal, early menopause (aged < 48 years); average menopause (aged 48-53 years) or late menopause (aged > 53 years). Women who were premenopausal but older than 53 years were assigned to the late menopause group, according to the study methods.

Hemodynamic assessment of pulse pressure was conducted during two or three sequential visits over 14 years of follow-up.

The researchers observed that pulse pressure decreased over time among participants younger than 40 years and was lower in women vs. men. After midlife, pulse pressure increased and was higher in women vs. men after age 60 years, according to the study.

After the researchers adjusted for vascular risk factors, pulse pressure was lowest at age approximately 47 years among men. In comparison, pulse pressure was lowest at age approximately 39 years in the premenopausal group, 38 years in the early menopausal group, 37 years in the average menopausal group and 37 years in the late menopausal group.

The time point at which pulse pressure was lowest among women was on average 6 years before menopause in the early menopausal group, 14 years before menopause in the average menopausal group and 19 years before menopause in the late menopausal group, according to the study.

“Healthcare professionals should definitely consider pulse pressure in middle-aged and older patients — especially women — with high blood pressure,” Mitchell said in the release. “Because women’s overall heart disease risk is lower, they are often told that a blood pressure that is ‘borderline’ — for example an upper number of 130 mm Hg — can just be watched. However, women and their doctors should sound the alarm if pulse pressure is higher than 60 mm Hg [such as 130/70 mm Hg] and track it over time to see if pulse pressure is rising.”