Advertisement
Canadian Journal of Cardiology

Cardiovascular Risk in Women: Focus on Hypertension

  • Beth L. Abramson
    Correspondence
    Corresponding author: Dr Beth L. Abramson, Cardiac Prevention Centre and Women's Cardiovascular Health, St. Michael's Hospital, 30 Bond St 6 -050 Queen Wing, Toronto, Ontario M5B-1W8, Canada. Tel.: +1-416-864-5424; fax: +1-416-864-5974.
    Affiliations
    University of Toronto, Cardiac Prevention Centre and Women's Cardiovascular Health, St Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Rochelle G. Melvin
    Affiliations
    University of Toronto, Cardiac Prevention Centre and Women's Cardiovascular Health, St Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:March 03, 2014DOI:https://doi.org/10.1016/j.cjca.2014.02.014

      Abstract

      Hypertension is a major concern in women, contributing to the risk for morbidity and mortality and the development of cardiovascular disease (CVD), heart attack, and stroke. A woman's risk for the development of hypertension increases with age. Although it also affects younger women, hypertension is prevalent in approximately 60% of women >65 years of age. In addition to age, there are specific risk factors and lifestyle contributors for the development of hypertension in women, including obesity, ethnicity, diabetes, and chronic kidney disease. Risk reduction strategies need to be used to help reduce hypertension; maintaining a healthy body weight through diet and exercise, reduced sodium intake, and lower alcohol intake are a few of the approaches for hypertension risk reduction in women. There are several proposed mechanisms for the development of hypertension that are unique to women and pertain to the aging-related elevated risk for hypertension resulting from falling estrogen levels during menopause. Oral contraceptives, pre-eclampsia and polycystic ovary syndrome are special considerations concerning the development and progression of hypertension in women. There are significant awareness issues and care gaps in the treatment of hypertension in women. Therefore, these problems must be faced and efforts need to be taken to resolve the issues surrounding the treatment and control of hypertension in women.

      Résumé

      L’hypertension artérielle qui est une préoccupation majeure chez les femmes contribue au risque de morbidité et de mortalité, et au développement de maladie cardiovasculaire (MCV), de crise cardiaque et d’accident cérébral vasculaire. Le risque de développement de l’hypertension chez la femme augmente avec l’âge. Bien qu’elle se manifeste également chez les plus jeunes femmes, l’hypertension est courante chez environ 60 % des femmes âgées de > 65 ans. En plus de l’âge, il existe des facteurs de risque spécifiques et des causes liées au mode de vie dans le développement de l’hypertension chez les femmes, dont l’obésité, l’ethnicité, le diabète et la néphropathie chronique. Des stratégies de réduction du risque doivent être utilisées pour aider à réduire l’hypertension; le maintien d’un poids santé au moyen du régime et de l’exercice, la réduction de l’apport en sodium et la diminution de la consommation d’alcool sont quelques-unes des approches pour réduire le risque d’hypertension chez les femmes. Plusieurs des mécanismes proposés dans le développement de l’hypertension n’existent que chez les femmes et concernent le risque élevé d’hypertension liée à l’âge et provoquée par la chute de la concentration en œstrogènes au cours de la ménopause. Les contraceptifs oraux, la prééclampsie et le syndrome des ovaires polykystiques sont des aspects particuliers à prendre en considération concernant le développement et la progression de l’hypertension chez les femmes. Il y a d’importants problèmes de sensibilisation et des lacunes en matière de soins concernant le traitement de l’hypertension chez les femmes. Par conséquent, ces problèmes doivent être surmontés et des efforts doivent être déployés pour résoudre les problèmes entourant le traitement et le contrôle de l’hypertension chez les femmes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2004. Available at: https://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm. Accessed March 3, 2014.

      2. Statistics Canada: Health Statistics Divison. Mortality, Summary List of Causes. 2009. Available at: http://www.statcan.gc.ca/pub/84f0209x/84f0209x2009000-eng.pdf. Accessed March 3, 2014.

      3. Statistics Canada. High Blood Pressure 2010. Available at: http://www.statcan.gc.ca/pub/82-625-x/2011001/article/11463-eng.htm. Accessed: February 17, 2014.

      4. National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD, National Center for Health Statistics (US); 2013 May. Report No.: 213-1232.

        • Lewington S.
        • Clarke R.
        • Qizilbash N.
        • Peto R.
        • Collins R.
        Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
      5. World Health Organization. Global Health Risks: mortality and burden of disease attributable to selected major risks. 2009. Available at: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. Accessed March 3, 2014.

        • Robitaille C.
        • Dai S.
        • Waters C.
        • et al.
        Diagnosed hypertension in Canada: incidence, prevalence and associated mortality.
        CMAJ. 2012; 184: 49-56
        • Geraci T.S.
        • Geraci S.A.
        Considerations in women with hypertension.
        South Med J. 2013; 106: 434-438
        • Bateman B.T.
        • Shaw K.M.
        • Kuklina E.V.
        • et al.
        Hypertension in women of reproductive age in the United States: NHANES 1999-2008.
        PLoS One. 2012; 7: e36171
        • Ford E.S.
        • Capewell S.
        Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates.
        J Am Coll Cardiol. 2007; 50: 2128-2132
        • Taddei S.
        Blood pressure through aging and menopause.
        Climacteric. 2009; 12: 36-40
        • Ong K.L.
        • Tso A.W.
        • Lam K.S.
        • Cheung B.M.
        Gender difference in blood pressure control and cardiovascular risk factors in Americans with diagnosed hypertension.
        Hypertension. 2008; 51: 1142-1148
        • Folsom A.R.
        • Prineas R.J.
        • Kaye S.A.
        • Munger R.G.
        Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women.
        Stroke. 1990; 21: 701-706
        • Paynter N.P.
        • Cook N.R.
        • Everett B.M.
        • et al.
        Prediction of incident hypertension risk in women with currently normal blood pressure.
        Am J Med. 2009; 122: 464-471
        • Shimomura T.
        • Wakabayashi I.
        Associations of cardiovascular risk factors with prehypertension and hypertension in women. 21. Blood Press, 2012: 345-351
        • Forman J.P.
        • Stampfer M.J.
        • Curhan G.C.
        Diet and lifestyle risk factors associated with incident hypertension in women.
        JAMA. 2009; 302: 401-411
        • Palatini P.
        • Mos L.
        • Santonastaso M.
        • et al.
        Premenopausal women have increased risk of hypertensive target organ damage compared with men of similar age.
        J Womens Health. 2011; 20: 1175-1181
        • Samad Z.
        • Wang T.Y.
        • Frazier C.G.
        • et al.
        Closing the gap: treating hypertension in women.
        Cardiol Rev. 2008; 16: 305-313
        • Li C.
        • Engström G.
        • Hedblad B.
        • Janzon L.
        Sex-specific cardiovascular morbidity and mortality in a cohort treated for hypertension.
        J Hypertens. 2006; 24: 1523-1529
        • Appel L.J.
        • Moore T.J.
        • Obarzanek E.
        • et al.
        DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure.
        N Engl J Med. 1997; 336: 1117-1124
        • Carlsson A.C.
        • Wändell P.E.
        • de Faire U.
        • Hellénius M.L.
        Risk factors associated with newly diagnosed high blood pressure in men and women.
        Am J Hypertens. 2008; 21: 771-777
        • Parker E.D.
        • Schmitz K.H.
        • Jacobs Jr., D.R.
        • Dengel D.R.
        • Schreiner P.J.
        Physical activity in young adults and incident hypertension over 15 years of follow-up: the CARDIA study.
        Am J Public Health. 2007; 97: 703-709
        • The Trials of Hypertension Prevention Collaborative Research Group
        The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels: results of the Trials of Hypertension Prevention, Phase I.
        JAMA. 1992; 267: 1213-1220
        • Abramson B.
        Heart Health for Canadians: The Definitive Guide.
        HarperCollins Canada, Toronto2013: 65-102
      6. National Heart Lung and Blood Institute: Health Information Network. 5 steps to a healthy weight. Available at: http://hp2010.nhlbihin.net/joinhin/news/consumer/ConsumerWtLossReality.htm. Accessed: January 26, 2014.

        • Forman J.P.
        • Rimm E.B.
        • Stampfer M.J.
        • Curhan G.C.
        Folate intake and the risk of incident hypertension among US women.
        JAMA. 2005; 293: 320-329
        • Svetkey L.P.
        Management of prehypertension.
        Hypertension. 2005; 45: 1056-1061
        • He F.J.
        • Li J.
        • Macgregor G.A.
        Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials.
        BMJ. 2013; 346: f1325
        • Xin X.
        • He J.
        • Frontini M.G.
        • et al.
        Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials.
        Hypertension. 2001; 38: 1112-1117
        • Reckelhoff J.F.
        • Fortepiani L.A.
        Novel mechanisms responsible for postmenopausal hypertension.
        Hypertension. 2004; 43: 918-923
        • Schunkert H.
        • Danser A.H.
        • Hense H.W.
        • et al.
        Effects of estrogen replacement therapy on the renin-angiotensin system in postmenopausal women.
        Circulation. 1997; 95: 39-45
        • Ibrahim M.M.
        RAS inhibition in hypertension.
        J Hum Hypertens. 2006; 20: 101-108
        • Komatsumoto S.
        • Nara M.
        [Changes in the level of endothelin-1 with aging].
        Nihon Ronen Igakkai Zasshi. 1995; 32: 664-669
        • Lima R.
        • Wofford M.
        • Reckelhoff J.F.
        Hypertension in postmenopausal women.
        Curr Hypertens Rep. 2012; 14: 254-260
        • Weiner C.P.
        • Lizasoain I.
        • Baylis S.A.
        • et al.
        Induction of calcium-dependent nitric oxide synthases by sex hormones.
        Proc Natl Acad Sci U S A. 1994; 91: 5212-5216
        • Mansego M.L.
        • Redon J.
        • Marin R.
        • et al.
        Renin polymorphisms and haplotypes are associated with blood pressure levels and hypertension risk in postmenopausal women.
        J Hypertens. 2008; 26: 230-237
        • Castelao J.E.
        • Gago-Dominguez M.
        Risk factors for cardiovascular disease in women: relationship to lipid peroxidation and oxidative stress.
        Med Hypotheses. 2008; 71: 39-44
        • Esler M.
        • Rumantir M.
        • Wiesner G.
        • et al.
        Sympathetic nervous system and insulin resistance: from obesity to diabetes.
        Am J Hypertens. 2001; 14: 304-309
        • Landsberg L.
        Diet, obesity and hypertension: an hypothesis involving insulin, the sympathetic nervous system, and adaptive thermogenesis.
        Q J Med. 1986; 61: 1081-1090
        • Keam S.J.
        • Wagstaff A.J.
        Ethinylestradiol/drospirenone: a review of its use as an oral contraceptive.
        Treat Endocrinol. 2003; 2: 49-70
        • Permu P.I.
        • Ofili E.
        Hypertension in women: Part I.
        J Clin Hypertens. 2008; 10: 406-410
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.J.
        Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis.
        BMJ. 2007; 335: 974
        • Roos N.
        • Kieler H.
        • Sahlin L.
        • et al.
        Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study.
        BMJ. 2011; 343: d6309
        • Klungel O.H.
        • Stricker B.H.C.
        • Paes A.H.P.
        • et al.
        Excess stroke among hypertensive men and women attributable to undertreatment of hypertension.
        Stroke. 1999; 30: 1312-1318
        • Ong K.L.
        • Cheung B.M.
        • Man Y.B.
        • Lau C.P.
        • Lam K.S.
        Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004.
        Hypertension. 2007; 49: 69-75
        • Wilkins K.
        • Gee M.
        • Campbell N.
        The difference in hypertension control between older men and women.
        Health Rep. 2012; 23: 33-40
        • Doner Lotenberg L.
        • Clough L.C.
        • Mackey T.A.
        • et al.
        Lessons learned from a survey of the diagnosis and treatment journeys of postmenopausal women with hypertension.
        J Clin Hypertens. 2013; 15: 532-541
        • Oparil S.
        Women and hypertension: what did we learn from the Women's Health Initiative?.
        Cardiol Rev. 2006; 14: 267-275
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • et al.
        2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
        JAMA. 2014; 311: 507-520
        • Mosca L.
        • Ferris A.
        • Fabunmi R.
        • Robertson R.M.
        American Heart Association. Tracking women's awareness of heart disease: an American Heart Association national study.
        Circulation. 2004; 109: 573-579