High blood pressure Factsheet

Blood pressure tends to rise with age, and high blood pressure raises the risk of heart attacks and stroke. Keeping an eye on your blood pressure, looking after your overall health and taking HRT (hormone replacement therapy) can all help lower your risk of heart disease.

Your blood pressure and the menopause

Your blood pressure is the force of your blood pushing against your blood vessel walls as it flows away from your heart and around your body. We all have blood pressure, but high blood pressure puts a strain on your heart and blood vessels and is a major cause of heart disease, stroke and many other diseases. Blood pressure tends to rise with age and it’s very common to have high blood pressure by the age of 60 – around two thirds of adults over 60 have it.

What is a healthy blood pressure?

The higher your blood pressure the higher the risks. A healthy range is from 90/60mmHg up to 120/80mmHg. If your blood pressure raises to 140/90mmHg or over, consistently, this would be diagnosed as high.

What raises your blood pressure?

As well as your age, your blood pressure can be raised by your genes, carrying extra weight, not exercising enough, eating a diet which is high in salt and saturated fat, smoking, drinking a lot of alcohol ­ it’s usually caused by a combination of things.

Why is healthy blood pressure important during and after the menopause?

Estrogen allows your blood vessels to relax and widen so that blood can flow through them easily, helping to keep your blood pressure down. It helps keep your cholesterol down too. Cholesterol is a type of fat found in the blood that can build up in the arteries and clog them up, leading to heart disease and stroke. High blood pressure and high cholesterol both raise the risk of heart disease, so it’s important to keep these under control.

Estrogen has other effects too. It reduces inflammation and improves nitrous oxide levels, a chemical which is known to relax and widen blood vessels. The drop in estrogen that happens during the menopause doesn’t directly raise your blood pressure, but it is linked to a much higher risk of heart disease and heart attacks. The risk of heart attacks is five times higher after the menopause than before, and heart disease is the leading cause of death for postmenopausal women. When estrogen falls, the cholesterol in your blood rises, and the other protective effects of estrogen are lost. If you have high blood pressure as well, these can all add up.

The change in hormones that happens with the menopause can sometimes make you feel tired and fed up, so you feel less like doing healthy things such as exercising and eating healthy foods, and simply getting older raises the risk of heart disease too.

HRT helps to lower the risk of heart disease in future

Women who start HRT during the perimenopause or within 10 years of the menopause (the time when periods have completely stopped for one year) have a lower risk of heart disease compared to women who don’t take HRT. Women who start taking HRT more than 10 years after menopause are also likely to have a lower future risk of heart disease.

After the menopause, women’s body shape tends to change and you might increase weight around your middle. This can lead to insulin resistance and diabetes which are linked to heart disease, and HRT can help with these effects. In addition, estrogen has an anti-­inflammatory response on the lining of the blood vessels as well as lowering cholesterol.

Can you take HRT if you have high BP?

For most women, it’s perfectly safe to take HRT if you have high blood pressure or you’re taking medicines to lower your blood pressure. Your doctor will simply need to keep an eye on your blood pressure and adjust your medicines if needed.

There is a lot of confusion around HRT and blood pressure and some women have been needlessly advised against HRT. However, a review of the evidence showed that postmenopausal women with normal and high blood pressure had a very low risk of a rise in blood pressure with all forms of HRT, and in fact their blood pressure was often lowered.

Estrogen taken as a tablet has the potential to raise blood pressure but taking estrogen through the skin as a patch, gel or spray allows your blood vessels to widen – so it can lower your blood pressure rather than raise it. Progestogens have different effects and while some could raise blood pressure, the newer type, called micronised progesterone, appears to have no effect or even lowers blood pressure. Women with raised blood pressure can still usually take HRT and it is safe to take blood pressure lowering medication with HRT.

Are there any risks with HRT for heart health?

There can be some small risks depending on your health and the type of HRT. Estrogen taken as a tablet is linked to a slightly higher risk of blood clot (venous thromboembolism). There is also a very small increased risk of stroke, but the overall risk of stroke in women under 60 is low.

These risks can be avoided by taking estrogen through the skin and taking the newer type of progesterone (micronized progesterone). Estrogen through the skin as a patch, gel or spray does not increase the risk of a blood clot.

Your doctor will also consider any other risk factors you have for heart disease before they prescribe HRT, including your age, family history, general health, weight, if you smoke, and whether you still have a uterus (womb). Then they can consider which type is suitable for you.

What else can you do to look after your heart health?
Taking care of your blood pressure and your overall health will help you lower your risk of heart disease and stroke after the menopause and into later life. Remember to:

– have a blood pressure check and take your blood pressure medicines if you are prescribed them
– have a cholesterol check
– be active
– try to be a healthy weight
– eat less salt
– eat less saturated fat
– eat a healthy diet with lots of fruit, vegetables and wholegrains, and avoid processed foods
– limit alcohol and stop smoking
– find ways to look after yourself, such as yoga and meditation.