Women and hypertension: Understanding the risks, taking control

With the increase in urbanisation and technological advancement, hypertension, i.e., high blood pressure (systolic pressure >140mm.Hg and diastolic pressure >90mm.Hg), has increased in prevalence around the world. It is a leading cause of sickness and death. Up to menopause, women are protected from cardiovascular diseases, due to the protective effect of oestrogen, but after menopause, they are more prone to develop cardiovascular problems due to hypertension. The estimated prevalence of high blood pressure in women worldwide is about 30 per cent. Therefore, it requires proactive management throughout a woman’s life. Certain risk factors make women more vulnerable to developing hypertension. Advancing age is one of them. The older a woman is, the greater the risk. Some risk factors for hypertension in women are the same as in men. These are; obesity (BMI, i.e. body mass index >25 or waist-hip ratio>85), lack of physical activity, excess salt consumption, excessive tea and coffee intake, lack of adequate relaxation, stress, use of alcohol and or tobacco, family history of high blood pressure, kidney diseases, medications like corticoids, over-the-counter anti-cold pills, hormonal disorders like hyperthyroidism, and Cushing’s syndrome. In women, the unique risk factors are a change of hormonal balance around menopause, oral contraceptive use, and PCOS (polycystic ovarian syndrome). Hypertension, if uncontrolled, can lead to damage to the heart, blood vessels, eyes, and kidneys. Women are more susceptible to developing cardiac problems, particularly after menopause. High blood pressure during pregnancy can lead to pre-eclampsia, eclampsia, which are life-threatening conditions. They are also at higher risk of stroke. Mostly, women in all societies tend to be negligent towards their diet and health. As per studies, undernutrition, particularly protein, calorie malnutrition, is also a risk factor for hypertension. Due to malnutrition, many women start suffering from high blood pressure and cardiac problems around or after menopause. Therefore, there is a need to create awareness among women to be careful about their own health and take due precautions to prevent hypertension. After 18 years of age, women should get their blood pressure checked regularly for early detection. Lifestyle modifications are necessary for the prevention and treatment of hypertension. This includes a balanced diet. Diet should have less salt and fat and more of fresh green vegetables, fruits, whole grains, nuts, healthy milk products, and fish. Regular physical exercise is very helpful. Exercise like brisk walking, light jogging, swimming, yoga, are beneficial in prevention and even management of high blood pressure. The only thing needed is regularity. Any exercise should be started with a low frequency and then increased gradually. A word of caution here: weight-lifting or pushing should be avoided as it can enhance blood pressure and even precipitate heart problems. Leading a stress-free life and adequate physical and mental relaxation are also very important to prevent hypertension. Meditation and breathing exercises are helpful for this. Alcohol, tobacco, and excess tea, coffee should be avoided. If lifestyle measures fail to control high blood pressure, or one has any symptom (like throbbing headache, sense of discomfort, etc.) or complication related to it, medicines are started immediately, which are mostly continued for life. The dose may be increased or decreased or the molecule changed, as per the need, but medicines should be continued and not interrupted. If adverse effects develop due to any medicine, the treating physician should be informed, and the dose of the medicine should be reviewed or changed. The treatment has to be individualised. Use of oral contraceptives, impact of pregnancy, and menopause should be considered in a woman who has hypertension and managed accordingly. If a woman has developed hypertension, there is no need to be anxious. Following lifestyle measures and taking regular medication are good enough in keeping it normal and preventing complications. Dr Rachna Pande is a specialist in internal medicine.

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Women and hypertension: Understanding the risks, taking control