High Blood Pressure In Women

Written by Dr Katie Stephens, GP

Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP). 

 

High blood pressure affects one in four adult women in England but probably more than half of these women don’t know their blood pressure is high. This is because in most cases, high blood pressure doesn’t cause any symptoms. This doesn’t mean it’s not serious, though. In fact, the opposite is true. High blood pressure (or hypertension if we use the medical term) is one of the biggest causes of strokes and heart attacks. It is also very easy to check with a machine, and treating it early enough can prevent someone from getting a stroke or a heart attack.

This article addresses some symptoms of high blood pressure that women may get. It also looks at how women may be affected differently by hypertension than men. However, it’s important to realise that not having any symptoms doesn’t mean that your blood pressure is ok. Whether or not you have symptoms, if you haven’t had your blood pressure checked recently, please make it a priority to check it soon. Read on for tips on where to get this done.

Symptoms of high blood pressure in women

As stated above, the vast majority of people (women included) with high blood pressure will not have any symptoms. It’s possible to even have a dangerously high blood pressure and still feel perfectly fine in yourself. However, if someone is going to get a symptom from high blood pressure, they may experience one of the following:

• Headache
• Visual changes
• Shortness of breath
• Chest Pains
• Confusion
• Palpitations
• Sweating (including night sweats or hot flushes)
• Abdominal pain

If the top number of your blood pressure is 180 mmHg or higher, or if the bottom number is 120 mmHg or higher, and you have any of the above symptoms or just feel generally unwell, this is a medical emergency. Please either ring 999 or have someone take you to A&E immediately.

If your reading is 180/120 mmHg or higher and you don’t have any of the above symptoms and are feeling fine, please sit quietly for 5 minutes and repeat your reading. If it is still 180/120 mmHg or higher, please ring 111 now for further medical attention.

High blood pressure and menopause

The risk of having high blood pressure goes up as a woman gets older. It affects one in four adult women overall, compared to around three out of four women over the age of 60y. After menopause (which can happen at a range of ages, with the average being 51y in the UK), hypertension is actually more common in women than in men of the same age.

During the menopause, the body’s oestrogen levels drop. There are several ways that lower oestrogen levels can raise blood pressure:

• Increased salt sensitivity
• Weight gain
• Increased levels of other hormones (renin, androgens) which then raise blood pressure
• Reduced sensitivity to insulin

The other important factor here is that high blood pressure can cause hot flushes and other symptoms that mimic menopause. Women may be told that their chest pain, palpitations or shortness of breath are due to stress or are a menopausal symptom, when actually they are due to undiagnosed high blood pressure. Chalking symptoms up to the menopause instead of checking blood pressure may be one reason why so many women in this age range have high blood pressure but aren’t aware.

Is high blood pressure controlled better in women or men?

High blood pressure also isn’t treated or controlled as well in women as it is in men, despite women being more likely to take their medication and see their doctor. The reason for this may be damage from something called ‘nocturnal nondipping of blood pressure’, which appears to be more harmful in post-menopausal women (women who have been through the menopause) than men of the same age.

What is ‘nocturnal nondipping of blood pressure’? This may sound complicated but really all it means is that blood pressure is staying high overnight instead of dropping down lower, like it normally would do in other people. As the heart is a dynamic organ, it can change how tightly it squeezes (and our blood vessels can also squeeze tighter or relax looser), shifting the blood pressure higher or lower in response to what the body needs. A higher blood pressure means faster delivery of nutrients and oxygen to the cells in our bodies. A lower blood pressure means a slower delivery.

Usually, when we sleep, we don’t need quite as much oxygen or energy, and so our heart and blood vessels can relax a little, causing our blood pressure to drop lower overnight. This can give our internal organs a bit of breathing space, as they take a break from being on the receiving end of a hammering from a blood pressure that is too high. After women go through the menopause, they are less likely to have this overnight drop in blood pressure. Having a blood pressure stay high throughout the night as well as the day can lead to damage to the organs building up more quickly. This, in turn, increases the risk of serious conditions like heart attacks, strokes, kidney disease and dementia.

For some reason, even when men of the same age have their blood pressure stay high overnight like women, it doesn’t appear to cause as much damage to their organs as it does in women. We don’t know exactly why this happens. It may be that women are not treated as aggressively with medication, or that the medication is less effective in women, or potentially a third reason that we haven’t yet identified.

The bottom line here is that all women, especially those over the age of 50y, should have their blood pressure measured regularly, as many of them will have high blood pressure. For any woman with hot flushes, palpitations, chest aches, or brain fog, it is particularly vital that she have her blood pressure checked and not just assume that her symptoms are due to the menopause.

Conclusion

High blood pressure is a dangerous condition. It is one of the main causes of strokes and heart attacks but it is often silent, with most people never having any symptoms. Women may be particularly at risk of damage from high blood pressure:

• High blood pressure is more common in post-menopausal women than men of the same age
• Women of menopausal age might be told their symptoms are due to menopause, when in fact they could be due to a raised blood pressure
• Women tend to have worse blood pressure control than men, despite seeing their doctor more regularly and generally doing a better job of taking their medication
• Blood pressure that stays high overnight appears to cause more damage in women than in men

If you are a woman, and you haven’t had your blood pressure checked in the last 6 months, please make it a priority to do this soon. Don’t rely on the absence of any symptoms. The older you are, the greater the chance of your blood pressure being high and causing damage inside you. The good news is that high blood pressure is very much treatable and this damage can be prevented.

It is easy to check your blood pressure for free at many pharmacies, GP waiting rooms and gyms. Or, you could book an appointment with the nurse at your local NHS surgery, or pick up an inexpensive blood pressure machine to check it yourself at home. Pop your reading in our blood pressure tool to get instant feedback and advice.

For more information about high blood pressure, please see our definitive blood pressure guide or speak to your GP.