By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Ladies, listen up! Contrary to popular belief, high blood pressure is not just “a man’s problem.” According to the American Heart Association (AHA), women make up almost half of all adults with hypertension, a leading risk factor for cardiovascular disease. As women age, their risk increases: post-menopausal women – starting at age 65 – are more likely to have high blood pressure than men. Medication may be necessary to control blood pressure, though I like to try lifestyle modification first. Here are some facts about women and hypertension, and what to do about it…
What Women Need to Know about Hypertension
If you have high blood pressure you are three times more likely to develop coronary artery disease, six times more likely to develop heart failure, and seven times more likely to have a stroke. These events occur because high blood pressure damages arterial walls, leading to inflammation and plaque formation, and narrowing and hardening arteries. When this scenario develops in the carotid arteries feeding the brain, you are at increased risk for a stroke; in the coronary arteries feeding the heart muscle, you are at increased risk for heart attacks and heart failure; and in the arteries feeding the lower extremities, peripheral artery disease can develop and problems with mobility.
As we get older, arteries naturally harden and become less elastic over time. But uncontrolled high blood pressure accelerates the process.
Blood pressure is part and parcel of how the heart and circulatory system works. Your heart contracts and pushes blood through the arteries all the way to the far corners of your body. This force is known as systolic blood pressure. A normal systolic pressure is less than 120 millimeters of mercury (mm Hg), the measurement used to determine blood pressure levels. A reading of 120 to 139 is referred to as borderline (or prehypertension) high blood pressure, and 140 and above is high blood pressure.
The second number in a blood pressure reading is the diastolic number and refers to the pressure in the arteries when the heart relaxes between beats. You want a number less than 80. A reading of 80 to 89 means prehypertension; 90 or higher is high blood pressure.
High blood pressure is a silent killer because typically there aren’t any symptoms. You need to know your blood pressure numbers. A long-standing myth is that high blood pressure produces headaches. That can happen but typically only when blood pressure levels go dangerously high, such as a systolic level of 180 and above, or diastolic of 110 and above. Those are crisis levels and can be accompanied by severe headaches, severe anxiety, shortness of breath, and nosebleeds.
The fact is that high blood pressure is mostly symptomless, so you shouldn’t expect symptoms to alert you to your condition. That’s why you need to have a regular check-up and pay attention to your numbers.
Over the years, in articles and lectures, and with my own patients, I have tried to educate women to be alert to the problem of high blood pressure and dispel the common belief among them that high blood pressure isn’t a woman’s concern. Aside from smoking cessation, hypertension control is actually the single most important intervention to reduce the risk of future cardiovascular events in women.
There is a slight but significant increase in blood pressure among women taking the widely prescribed, but risky, pharmaceutical hormone replacement therapy of equine estrogen (Premarin) and medroxyprogesterone (Provera) to relieve menopausal symptoms. I recall vividly a patient in her late fifties who had developed a leaking mitral valve related to a sudden increase in blood pressure. She had no history of hypertension. Her doctor prescribed different medications to which she didn’t respond. She then consulted a surgeon who wanted to operate on her valve. Looking for another opinion, she came to see me. I asked if she was on hormones. When she said “yes” I figured she was hypertensive because of the medroxyprogesterone which is known to cause coronary artery constriction. The resulting blood pressure increase likely was affecting her mitral valve. I took her off the hormonal drugs and she normalized. It was a dramatic eye-opener for me. If a woman desires hormonal therapy, she should only consider natural, bio-identical estrogen and progesterone under the supervision of a knowledgeable doctor.
In younger women, hypertension may be as much as three times more common among individuals taking oral contraceptives. For such a hypertensive person, stopping the pill may reduce systolic pressure by 15 points within six months.
During pregnancy, hypertension occurs in about 10 percent of cases, and can increase the risk of maternal and fetal death as well as developing subsequent high blood pressure.
Women with high blood pressure are much more prone to diastolic dysfunction (DD), a condition involving progressive stiffening of the heart muscle that compromises the heart’s pumping ability. It can lead to the most common and serious form of heart failure that affects women. Shortness of breath in a hypertensive woman is a symptom of DD and needs to be treated with metabolic cardiology (see my recommendations below) because standard medicine has no effective treatment.
How to Lower High Blood Pressure
According to a comprehensive 2012 review (Engberding) of the famous Harvard-based Nurses’ Health Study of factors influencing women’s health, researchers from Atlanta’s Emory University singled out six modifiable lifestyle and dietary factors that reduce the risk of hypertension: a body mass index under 25; 30 minutes daily of vigorous exercise; a diet featuring fruits, vegetables, and lean meats, poultry and fish, with a minimum of sweets and alcohol; non-narcotic analgesics taken less than once a week; and 400 mcg daily of supplemental folic acid, an important B complex vitamin.
In my own practice, I have always recommended lifestyle changes such as stopping smoking, improved diet, physical activity like walking or swimming, and weight loss if there is an overweight factor involved. Losing a little bit of weight can go far to reduce high blood pressure.
One very important strategy is dealing with stress. Even though stress and hypertension have been traditionally associated with men, that’s clearly an obsolete concept as well. Just ask any working mom, as an example. I recall a forty-year-old attorney who had a heart attack after divorcing her husband and moving out-of-state with her two young children to be close to her parents, one of whom had Alzheimer’s. Clearly, that’s a recipe for stress, high blood pressure, and heart problems. With good medical care, the woman survived her heart attack, and later came to see me about dealing with lifestyle and stress issues.
Stress reduction is critical and that means a woman needs to take some time for herself to relax, and deal in a corrective way with toxic emotions. Years ago, I conducted a co-ed study on stress and illness. I measured stress hormone breakdown substances in the urine at the beginning and at the end of the workshop. Most of the women were able to readily express their emotions and network with one another during the workshop. Not the men. They had extreme difficulty expressing their feelings. Their emotions appeared to be frozen. They were like lumps of clay. The men had extremely high levels of stress hormone breakdown in their urine, but not the women. The men had various degrees of heart disease. The women in the group had neither heart disease nor high blood pressure.
It’s a good point to remember − the value of networking, being real, and expressing your feelings. Women appear to be able to do this more readily by consulting with mothers, sisters, and girlfriends about health and other issues in life. In my opinion, this is an important and overlooked way to reduce stress and blood pressure. As a psychotherapist, I have long understood that held-in anger and resentment was a significant contributor to high blood pressure.
There are other ways to reduce stress as well, such as meditation, tai-chi, and yoga. You need to find a practice that resonates with you and stick to it. You need to make the time.
Years ago I developed a metabolic cardiology strategy that include a targeted nutritional supplement program. It can help a great deal to counteract hypertension for both men and women. It has the following ingredients:
- A high-quality multi vitamin and mineral formula.
- 100-180 mg of Coenzyme Q10 and 400-800 mg magnesium daily, both of which will help lower blood pressure.
- 1-2 g omega-3 fatty acid (fish or squid oil)
- For stubborn hypertension, I add nattokinase, an enzymatic supplement available in health food stores derived from the fermented Japanese soy dish called natto. Nattokinase helps to thin blood and make it easier for the heart to pump blood through the circulatory system. Extra-thick blood feeds the inflammatory process that damages arteries. Start with 50 mg daily and then increase to 100 mg after a week.
One more thing I highly recommend is Earthing, that is, reconnecting to the Earth’s healing energy by being barefoot outdoors or sleeping, working, or relaxing indoors on Earthing sheets or mats. Earthing has the potential to generate magnificent healing benefits such as improved circulation, reduced inflammation, pain, and blood pressure, a calming effect on the nervous system, better sleep, and more energy.
Finally, medication may be necessary to bring down stubborn high blood pressure. In cases like that, you should work with a skilled doctor who can sort out the gender effects of different drugs and minimize or avoid side effects. Researchers have now become increasingly aware of significant differences between hypertensive men and women that relate to hormonal, biochemical, and other dynamic mechanisms in the circulation of blood. These factors, according to a 2014 study (Ferrario) at Wake Forest University School of Medicine, may make women more vulnerable to vascular disease than men with the same elevated blood pressure level. Identifying these factors can better help physicians optimize a treatment program.
- The American Heart Association (AHA). High Blood Pressure and Women. Heart.org, accessed April 24, 2014.
- AHA. Menopause and Heart Disease. Heart.org, accessed April 24, 2014.
- US Dept. of Health and Human Services. “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.” Nhlbi.nih.gov, accessed April 24, 2014.
- Engberding N, Wenger NK. Management of Hypertension in Women. Hypertension Research 35, 251-260 (March 2012).
- Ferrario CM, Jessup JA, Smith RD. Hemodynamic and hormonal patterns of untreated essential hypertension in men and women. Ther Adv Cardiovasc Dis, Dec. 2013;7(6):293-305.
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