Key takeaways:

• One in four women with hypertension have their BP under control.
• Reproductive health impacts BP throughout women’s lives.
• Antihypertensive therapy improves heart health as much in men as it does women.

PHILADELPHIA — Women may have higher risk for heart disease related to elevated blood pressure compared with men, yet only one in four with hypertension have their BP under control, a speaker reported.

At the Heart in Diabetes CME Conference, Healio | Cardiology Today Editorial Board Member Erin D. Michos, MD, MHS, FAHA, FACC, FASE, FASPC, director of women’s cardiovascular health at Johns Hopkins School of Medicine, discussed how women’s BP can be affected by reproductive health and why it’s important to monitor BP throughout their life course.

One in four women with hypertension have their BP under control. Image: Adobe Stock

“Before midlife, women actually have lower BP than men, but after midlife, women have higher BP,” Michos told Healio. “Women are on a steeper change of blood pressure throughout their life. When it relates to CVD, hypertension remains the leading modifiable risk factor for CVD, and the risk of CVD in women starts taking off at a lower BP threshold compared to their male counterparts.”

Approximately one in four women aged 40 years and older with hypertension have their BP under control, according to data cited from NCHS Data Brief in October 2024.

Risk for CVD in women is estimated to become significant at BP thresholds as low as 100 mm Hg to 109 mm Hg systolic BP, whereas in men, significant risk is not observed until a threshold of 130 mm Hg to 139 mm Hg systolic, according to the presentation.

Michos said key reproductive factors contribute to changes in women’s BP throughout their lives, including early or late age at menarche; polyendocrine metabolic ovarian syndrome, infertility and adverse pregnancy outcomes during early reproductive years; final parity and lack of breastfeeding during late reproductive years; and menopause among older women.

“Having a hypertensive disorder of pregnancy is a real red flag of risk,” Michos told Healio. “Not only did these women have greater risk of CVD later in life, but they also have an eightfold increased risk for incident hypertension, even if their BP normalizes after delivery. We have to follow them really closely for their BP after delivery.

“Then at menopause, there are a lot of cardiometabolic changes that happen, and BP rises in many women after menopause,” Michos said. “Women have higher aldosterone levels, higher renin levels, more activation of the renin-angiotensin-aldosterone system after menopause. Women become more salt-sensitive and have more insulin resistance, more sympathetic activity. This can lead to these BP rises with the loss of estradiol at menopause, and women who have more severe vasomotor symptoms — those are your hot flashes and night sweats, more persistent and more frequent — are more likely to develop incident hypertension as well as incident CVD.”

Michos said for women who are menopausal, hormone therapy (HT) may reduce aldosterone levels; however, not all women are eligible for menopausal HT.

For women considering menopausal HT, their physician should evaluate age and time since menopausal transition; perform atherosclerotic CVD risk assessment to exclude contraindications for HT; and conduct routine follow-up with reevaluation of project risk and benefit, according to the presentation.

Lowering BP has a similarly cardioprotective effect among men and women across all BP levels at baseline, according to data cited from Hypertension. In addition, the researchers showed that the treatment benefits were also consistent regardless of age and type of antihypertensive therapy.

Michos said a mobile health self-management program using targeted, sex-specific coaching techniques effectively reduced BP among women to a greater extent compared with men, even among women undergoing the menopausal transition period. Full details on the mobile health intervention were published in the American Journal of Preventive Cardiology.

As Healio previously reported, the mobile health program conferred significant reductions in systolic BP over time (beta = –0.04; P < .001), with a noteworthy interaction between time and sex (beta = 0.01; P = .029) and larger reductions over time among women (beta = –0.18) vs. men (beta = –0.15).

“The good news is that women benefit just as much as their male counterparts with treatment of hypertension, [using] both nonpharmacological and pharmacological agents. Every 5 mm Hg lower of BP can reduce major CV events by 10%. We just need to treat women. But unfortunately, only one in four women with hypertension actually have their BP controlled.”

For more information:

Erin D. Michos, MD, MHS, FAHA, FACC, FASE, FASPC, is professor of medicine and director of women’s cardiovascular health at Johns Hopkins School of Medicine and a Healio | Cardiology Today Editorial Board Member. Michos can be reached at cardiology@healio.com.