Why it's important to spot hypertension in women going through the menopause

A cardiologist has highlighted the importance of spotting hypertension in menopausal women. 

The European Society of Cardiology (ESC) has published a consensus document authored by Professor Angela Maas, which alerts doctors to look out for hypertension in middle-aged women. 

The professor, director of the Women's Cardiac Health Programme, Radboud University Medical Centre, Nijmegen, the Netherlands commented: ‘High blood pressure is called hypertension in men but in women it is often mistakenly labelled as 'stress' or 'menopausal symptoms'. 

Professor Maas added: ‘We know that blood pressure is treated less well in women compared to men, putting them at risk for atrial fibrillation, heart failure and stroke -- which could have been avoided.’

Why biological sex matters in heart disease detection

Pointing out the fact that biological sex is vital in medicine, she said: ‘A woman's life provides clues that you need to start early with prevention. We have to assess female patients differently to men, and not just ask about high cholesterol. This will enable us to classify middle-aged women as high-risk or lower risk for cardiovascular disease."

This echoes finding by feminist campaigner Caroline Criado Perez in her book Invisible Women: Data Bias in a World Designed for Men, where she pointed out research form Leeds University which revealed UK, women are 50 percent more likely to be misdiagnosed after a heart attack.

‘The fact that we are still misdiagnosing these women is shocking,’ said Caroline Criado Perez. ‘We call female heart attack symptoms atypical, but they are actually very typical — for women. And we’ve known about the female symptoms [like stomach pain, breathlessness, nausea, and fatigue] for a long time now, because cardiovascular research is the field where the most work has been done on sex differences. [Misdiagnoses continue in part because some doctors practicing today were trained on medical textbooks and case studies that depict heart attack victims as men.]’

Women and hidden heart disease

• Pre-eclampsia is linked with a four-fold increase in heart failure and hypertension and a doubled risk of stroke
• Women who have an early natural (i.e. not surgical) menopause before the age of 40 are also more likely to develop cardiovascular disease -- each year is associated with a 3% raised risk.
• Autoimmune inflammatory conditions such as rheumatoid arthritis and lupus are more common in women compared to men and increase cardiovascular risk around menopause
• High blood pressure during pregnancy is a warning sign that hypertension may develop when a woman enters menopause 
• High blood pressure is associated with dementia many decades later

Professor Maas commented: ‘If blood pressure is not addressed when women are in their 40s or 50s, they will have problems in their 70s when hypertension is more difficult to treat.’

While HRT is effective in easing night sweats and hot flushes in women over 45, the authors recommend assessment of cardiovascular risk factors before initiation, because of the heightened risk of blood clots. 

Care for transgender women (persons assigned male at birth) also needs to be particularly tailored. ‘These women need hormone therapy for the rest of their lives and the risk of blood clots increases over time’ explained Professor Maas.

Ultimately, better communication between disciplines such as cardiology, endocrinology and gynaecology is vital – as is listening to patients. Professor Maas urged women to be proactive in giving full medical histories to physicians caring for them.  ‘Women can help their doctors prevent heart problems and make earlier diagnoses by mentioning issues like complicated pregnancies and early menopause and monitoring their own blood pressure.’

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