Hypertension is often called the “silent killer”. Why is high blood pressure particularly concerning for women?

Hypertension or high blood pressure as it is commonly known often has no symptoms and why it is referred to as “silent killer” leading to over 10 million deaths each year worldwide. It is particularly important that women recognise hypertension is the primary risk factor for cardiovascular disease, the leading cause of death for women. There are also female-specific factors which will impact on their blood pressure, such as oral contraceptives, pregnancy, menopause, polycystic ovary syndrome. Other conditions which are more prevalent in females include autoimmune disease and fibromuscular dysplasia (abnormal development or growth of cells in the walls of arteries that can cause the vessels to narrow or bulge). It is particularly important for women to recognise that although blood pressure may have returned to normal after pregnancy, they need to ensure they continue to monitor their blood pressure to prevent heart disease. Their risk for heart disease can appear years later and why it is essential to inform their physician/health professionals. There is strong clinical data showing control of hypertension can reduce cardiovascular disease risk in women.

You emphasise the importance of blood pressure monitoring before menopause. What changes occur during this stage that make early detection so crucial?

Regular blood pressure monitoring at all ages is the best strategy to prevent cardiovascular disease. In fact, adopting a “Know Your Numbers” strategy. For example, normal blood pressure would be less than 120/80 mmHg (according to Heart Foundation Guidelines). It is also considered important to know your cholesterol and blood glucose levels and weight as routine will prevent/reduce the high risk of cardiovascular disease for women during menopause. Although young women have lower blood pressure than men at the same age, research into sex differences shows that the increase in blood pressure across lifespan is steeper for women, starting as early as in their third decade. In addition, further research into sex differences for the risk of cardiovascular disease such as heart attack, heart failure and stroke show increased risk associated from lower blood pressure range (100-110 mmHg) in women compared to men (130-139 mmHg). Most women have “pear-shaped” fat distribution pattern –more fat in hips and thighs rather than waist and central abdominal for men, which is associated with lower diabetes and cardiovascular disease risk. However, when women become obese before menopause, they have a greater risk of developing hypertension compared to men and why we ask women to have their blood pressure monitored. There have also been studies showing that women have greater age-related arterial stiffness which starts a decade earlier than men. Hypertension in midlife is associated with cognitive decline and dementia in women compared to similarly aged men with hypertension.

What are the most effective ways for women to measure their blood pressure accurately at home or in a clinical setting?

Using validated blood pressure monitors in both the clinic and home to measure BP is the first important step to accurate measurement. There are free websites such as STRIDEBP.org or ValidateBP.org which list monitors that have been confirmed. For women, measurement of blood pressure away from clinic is also recommended due to their experiencing “white-coat effect”. This can be achieved with either ambulatory blood pressure monitoring or home monitoring. The procedures for measuring blood pressure at home or in clinical setting are the same and it is important that they follow these procedures to ensure accurate measures. These include ensuring that you have not had coffee or tea for 30 mins before measurement, making sure you have an empty bladder and sitting with feet on floor (not crossed) and back supported. The arm that has the cuff applied should be supported and no talking during measurement by either physician or patient. Importantly, for home and clinic measurement, there should be five minutes rest.

Lifestyle plays a big role in blood pressure control. What are some of the key changes women can make to help keep their blood pressure in a healthy range?

Incorporating lifestyle modifications as part of the treatment plan can significantly assist women in maintaining control of their blood pressure. These include a balanced, high fibre diet, reducing the amount of alcohol, salt in their diet and avoid smoking. Engaging in physical activity, any type, regularly is key to cardiovascular health and longevity as well as assists in maintaining stable weight. Increased weight gain, especially near or after menopause is a major cardiovascular risk factor for women. Sleep time is also important as well as quality of sleep. Connecting with friends or engaging in a hobby encourages positive mental health. Women experience more anxiety and depression which have been shown to contribute to greater heart disease risk. Personalising management to ensure cultural sensitivities are maintained is key to adherence.

On a personal note, what do you do to take care of your own heart health?

It has been 2 years since I lost my dear mother. It is vital that we all take care of our own heart health and for me it involves having an annual heart health check since I have higher risk of cardiovascular disease as my mother had hypertension during pregnancy. I did develop hypertension but with regular monitoring and medication, it is controlled. I ensure I walk a minimum of 30 minutes each day as well as balance and flexibility exercises. Simple squats while I am waiting for the lifts or using the stairs instead of lifts and walking. If I am having a challenging day, I will take 5 minutes to look at the sky and clouds and marvel at their formation. Having Greek heritage, I have a mediterranean Greek diet and connect with family and friends. Social interaction is good for the heart as well as laughter as the saying goes “Laughter Is the Best Medicine”. My mother had no medical training but had strong positivity and am pleased to see that this is now being recognised as a common trait in super agers. I am trying to learn that skill as there have been many challenges but her legacy was to “Keep Going!”

It was a pleasure interviewing Dr Mihailidou and gaining insights from her experience. To learn more about her work, you can connect with her on:

Twitter: @AnastasiaSMihai
LinkedIn: www.linkedin.com/in/anastasia-s-mihailidou
BlueSky: @anastasiasmihaili.bsky.social
Website: https://kollinginstitute.org.au