Hypertension Across a Woman's Life Cycle

Abstract

Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.

Keywords: hypertension; pregnancy-related hypertension; prevention; race and ethnicity; women.

Figure 1. Hypertension across a woman's life cycle

Figure 2. Deaths attributable to individual risk factors, by disease

PUFA, polyunsaturated fatty acids; SFA, saturated fatty acids. (Danaei G et al.(90)) [From PLos Med, permission for reuse granted under the Creative Commons Attribution License].

Central Illustration. Hypertension prevalence, U.S. adults aged ≥18, by sex and age 2011–14

¹Crude estimates are 31.3% for total, 31.0% for men, 31.5% for women.²Significant differences from age group 18–39; ³age group 40–59; ⁴women for same age group. ⁵Significant linear trend. Estimates for the 18 and over category were age-adjusted by the direct method to the 2000 U.S. census population using age groups 18–39, 40–59, and 60 and over. (CDC/NCHS NHANES, 2011–2014)