Despite knowledge gaps that still exist, effective treatment and control of hypertension may improve cardiovascular outcomes affecting women in different phases of their life cycle, according to a state-of-the-art review published April 16 in the Journal of the American College of Cardiology.

Nanette K. Wenger, MD, MACC, et al., describe the burden that hypertension has on women, as it is among the “most important risk factors” for developing cardiovascular disease and accounts for about one in five deaths in U.S. women. They highlight ways hypertension affects women in multiple phases of life, with specific characteristics relating to risk factors in teenage and young adult women; pregnancy; use of oral contraceptives and assisted reproductive technologies, lactation, menopause or hormone replacement; elderly women; and issues of race and ethnicity.

The authors point out common risk factors that offer opportunities to affect hypertension and cardiovascular disease burdens in women, including obesity, physical inactivity, increased salt intake, diabetes and alcohol use. They also offer sex-specific risk factors that mediate hypertension development such as estrogen receptors and sympathetic nervous system activation, pregnancy complications like pre-eclampsia and combinations of modifiable factors.

To control these risk factors, the authors encourage a multipronged approach to blood pressure management in women throughout all stages of life. “Critically important for U.S. women, hypertension carries the highest attributable risk for all-cause, as well as cardiovascular mortality and cognitive impairment; among modifiable risk factors, blood pressure management is a key health care priority for all women, particularly elderly women,” the authors write.

The authors note that knowledge gaps persist such as the contribution of hypertensive disorders of pregnancy to future cardiovascular disease in women, postpartum surveillance of women and optimal management of pre-eclampsia. They add that some believe that “optimal blood pressure targets have not been established by the highest level of evidence, particularly for older women.”

Despite the need for further specific research on hypertension in women, the authors conclude that “control of hypertension reduces cardiovascular disease-related adverse outcomes that contribute to poor quality of life, disability and health care resource consumption.”

Keywords: Pregnancy, Female, Blood Pressure, Risk Factors, Pre-Eclampsia, Receptors, Estrogen, Contraceptives, Oral, Quality of Life, Hypertension, Lactation, Breast Feeding, Menopause, Obesity, Diabetes Mellitus, Sympathetic Nervous System, Reproductive Techniques, Assisted

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