Hypertension in Women

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Like heart disease, high blood pressure has always been thought of as a man’s problem—but it just isn’t so. Both are equal-opportunity afflictions. High blood pressure, also known as hypertension, affects one out of every four women, and kills significantly more women than men.

As a woman with my own family history of hypertension, heart disease, and stroke, I know my risks and those of my children and grandchildren all too well—so it seems natural to write about the subject. I last updated myself on it more than five years ago while helping Dr. Sinatra with his book Lower Your Blood Pressure in Eight Weeks (Ballantine, 2003). Today we know a lot more about the condition, and it’s not pretty.

High blood pressure is a serious problem for women. It’s linked to heart disease and stroke as well as degenerative conditions like type 2 diabetes and renal failure. It can shorten a woman’s life span by 10–20 years. Only about 60 percent of hypertensive women are treated, and, according to experts, only about a third of them are able to control their blood pressure at optimum levels.

In our younger years, the women in my family have had a good track record of warding off elevated blood pressure. If anything, we are almost hypotensive (blood pressure that’s too low). Our systolic blood pressure hovers around 100, and our diastolic pressure around 60. After menopause, however, the situation changes—and not for the better. In my experience, I’ve found that this pattern is not unusual.

The mainstream medical community used to think that being a man, in and of itself, was a risk factor for developing high blood pressure and heart disease, and that women were protected by estrogen. Though we don’t fully understand how estrogen—or which form of it—may play a role, one thing has become clear: As our natural levels of estrogen taper off, our blood pressure numbers creep up the sphygmomanometer scale (that’s the instrument that measures your blood pressure).

Despite its connection with aging, there’s no reason for maturing women to accept that hypertension is a natural part of getting older, or that taking medication is the only solution. Instead, I find it helpful to look at a woman’s risk for high blood pressure in the context of her choices in three important parts of adult life: birth control, pregnancy, and menopause.

Causes of High Blood Pressure Specific to Women

1. Birth Control

Oral contraceptives (OCs) may elevate blood pressure slightly. Usually a woman’s numbers will stay in the normal range, but they should be checked regularly because high blood pressure is a potential side effect—particularly for women with a family history of hypertension or a personal history of kidney disease, obesity, or hypertension during pregnancy.

Smoking while taking OCs dramatically increases the risk of stroke or heart attack from a blood clot. Nicotine causes blood vessels to constrict a bit, and some of the other 4,000 toxic agents in cigarettes make platelets sticky—a potentially lethal combination. If a woman cannot stop smoking, she should choose another method of birth control.

2. Pregnancy

Many hypertensive women deliver healthy babies, but pregnancy—and the increased blood volume required to nurture a growing fetus—can potentially raise blood pressure to high levels. As many as 1 out of every 10 pregnancies is complicated by hypertension, and this is dangerous for both mother and child. Since the early 1900s, intravenous magnesium has been used to treat pre-eclampsia, a dangerous hypertensive disorder of pregnancy, and a leading cause of premature birth, low birth weight, and death of both infant and mother. One of Dr. Sinatra’s tried-and-true recommendations for high blood pressure during pregnancy is magnesium. He suggests hypertensive women take 300–400 mg daily under the close supervision of their doctor.

Because hypertension can also harm the kidneys, any woman with known kidney problems or chronic high blood pressure should seek medical advice before conceiving, and receive comprehensive prenatal care during pregnancy. Expectant mothers also should have their blood pressure checked routinely. Hypertension can develop rapidly in the last three months of pregnancy. If this happens, a woman may need treatment—even after delivery—if her blood pressure does not normalize.

3. Menopause

Hormonal declines render our arteries less elastic and more constrictive, thus contributing to high blood pressure. Aging also increases the activity of the sympathetic nervous system. This branch of the autonomic nervous system is closely involved with the fight-or-flight response, and it sets the table for hypertension during our body’s response to stress. More sympathetic stimulation means the potential for higher blood pressure. (It’s important to note that the activity of the sympathetic nervous system increases with age regardless of menopausal status, but it is especially important in postmenopausal women who’ve lost the protective effects of estrogen.)

The relationship between blood pressure and the hormones made by our own body is rather complex, so doctors don’t know for sure how conventional hormone replacement therapy (HRT) fits into the equation. HRT usually involves unnatural pharmaceutical substitutes for the hormones our bodies produce naturally. There are, however, indications that these synthetic hormones may be problematic. In 2004, results from the large Women’s Health Initiative (WHI) study showed that Premarin, the pharmaceutical estrogen made from the urine of pregnant mares, pushed blood pressure up steeply.

Premarin is not the only troubling hormonal substitute, either. Dr. Sinatra recalls treating a 58-year-old woman for high blood pressure, despite the fact that she had no obvious risk factors. Her health and weight were good; she didn’t smoke. She reported not taking any medications. She didn’t feel her life was particularly stressful. But after talking to her for a while, he learned that she was taking Provera (medroxyprogesterone acetate), the pharmaceutical form of progesterone. She had not considered Provera a drug when she filled out her medical history, but she was willing to discontinue it when he told her he’d seen many women develop high blood pressure while taking it. Sure enough, at her next office visit, her blood pressure was back to normal!

The answer to the HRT dilemma is that individually tailored bioidentical hormones that are derived from natural plant sources represent a better option for women. Instead of leading to constriction of arterial walls, bioidenticals may soften them.
Other High Blood Pressure Concerns

Aside from the major life decisions women make regarding their reproductive lives, there are a number of other factors that can influence blood pressure.

Metabolic syndrome. Data from a five-year National Health and Nutrition Examination study of hypertensive adults revealed three risk factors for high blood pressure that are more significant for women than men: low HDL level, elevated total cholesterol, and excess abdominal fat (waist girth more than 35 inches). This profile is largely consistent with metabolic syndrome, a widespread, asymptomatic condition that often leads to diabetes and heart disease.

Dr. Sinatra has observed that women with these characteristics typically don’t respond well to hypertensive medication. They do better with lifestyle changes that include exercise, weight loss, stress reduction, and targeted nutrients. For a step-by-step way to bring about remedial changes using lifestyle changes, please check out our book Lower Your Blood Pressure in Eight Weeks. It’s a great resource.

Diastolic dysfunction. Dr. Sinatra believes women have a tougher time with high blood pressure because they tend to have more diastolic dysfunction (DD) than men. DD is a condition in which the left ventricle—the chamber that generates your systolic blood pressure—becomes stiff. This is the number one cause of heart failure in women. DD may have to do with women’s smaller blood vessels and declining energy levels in the heart. Fortunately, the latter reason can be combatted with just a few nutritional supplements to boost flagging cellular energy in the heart and elsewhere, and, in the process, reduce high blood pressure. Dr. Sinatra’s daily recommendations are:

  • CoQ10: 100–200 mg of hydrosoluble ubiquinone
  • Magnesium: 400–500 mg of a broad spectrum magnesium
  • D-ribose: 5 g twice daily
  • L-carnitine: 1–1.5 g twice daily on an empty stomach

Painkillers. Daily doses of nonaspirin painkillers, such as extra-strength acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (Advil and Motrin), increase the risk of developing high blood pressure. A 2005 Harvard study found that women who did not take painkillers had a 1–3 percent increase in risk every year. However, women who took more than 500 mg of acetaminophen (the amount in one extra-strength tablet) daily had a 93–99 percent greater risk of developing hypertension within three years than women who took less. Likewise, women who took more than 400 mg a day of over-the-counter NSAIDs (the equivalent of two ibuprofen) had a 60–78 percent greater risk for hypertension than women who took less than that amount. These revelations were especially alarming for patients looking for alternatives to prescription NSAID painkillers such as Vioxx, which was associated with higher risk for heart disease and taken off the market.

Thus, the widespread use of these painkillers may contribute to the high incidence of hypertension in the United States. For years now, Dr. Sinatra has been telling his patients and readers to avoid acetaminophen—especially the extra-strength variety—because of its potential to cause liver problems. He also regularly recommends avoiding NSAIDs because of potential side effects such as gastrointestinal bleeding, liver damage, and kidney dysfunction. Now there’s yet another reason for women to avoid these analgesics.

If you take painkillers regularly, be sure to inform your doctor and find out about safer medications. At our house, we use Traumeel, a homeopathic remedy available in health food stores or online at www.traumeel.com. You can buy it as a topical cream or sublingual tablet, and it works great for various muscle aches and pains—without the potentially devastating side effects.

Emotions. Years ago, Dr. Sinatra conducted a fascinating co-ed study on stress and the heart with his cardiac patients. He measured urine and blood pressure at the beginning and at the end of the workshop. The women who expressed their emotions and networked with one another during the workshop had lower levels of stress hormones. They also had lower blood pressures. This is a good point for us to remember: the value of spending time with other women and consulting with our moms, sisters, and girlfriends about our health and other life issues. (To read more about the importance of strong emotional relationships and heart health, visit Drsinatra.com.)

Last, but certainly not least, it’s important to stay positive. No woman is sentenced to a life of hypertension because of her DNA. It’s not our destiny! Our blood pressure reading is only a number, and more often than not, it’s within our control—if we make conscientious lifestyle choices about our nutritional needs, activity levels, and emotional well-being. Medication may ultimately be needed, but it should be the option of last resort, not the first.

[See also, by Jan Sinatra: “High Blood Pressure and Kids – The Shocking News.”]


“Women and Hypertension” originally appeared in the October 2009 issue of Dr. Sinatra’s monthly written newsletter, Heart, Health & Nutrition. HMDI has reprinted this article with permission from Healthy Directions, LLC (© 2009 Healthy Directions, LLC).

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