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Menopause may not drive rising pulse pressure after midlife, with changes beginning up to two decades before the final menstrual period, a study found.
Pulse pressure, the gap between the upper and lower numbers in a blood pressure reading, is influenced by the stiffness and width of the aorta, the body’s largest blood vessel.
The analysis found that women’s pulse pressure reached its lowest point and began rising in their late 30s, around a decade earlier than in men, regardless of when menopause occurred.
Researchers analysed data from the Framingham Heart Study, a long-running study of cardiovascular risk factors involving three generations of families in Massachusetts.
The study included 6,760 adult women assessed at three health visits over 14 years. Women were grouped according to whether they were premenopausal or experienced early, average or late menopause.
Women whose menopause was induced by surgery or medication were excluded. Researchers also analysed data from 3,248 adult men to examine differences between the sexes.
Pulse pressure typically falls between early adulthood and midlife as the internal space within the aorta increases in diameter, allowing blood to flow more easily.
After midlife, pulse pressure tends to rise as the aorta stops widening and its walls become stiffer. A wider pulse pressure means the heart has to work harder and can contribute to damage in small blood vessels in organs including the brain and kidneys.
The researchers found that the age at which women’s pulse pressure changed from falling to rising was not affected by whether their final menstrual period occurred early, late or at a typical age.
After midlife, pulse pressure increased with age in both women and men, although it rose faster among women. Average pulse pressure was higher in women than men after the age of 60.
Gary F. Mitchell, senior author of the study, said: “To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife.”
The findings challenge the assumption that hormonal changes associated with menopause contribute to the increase in aortic stiffness seen among women later in life.
However, the observational study could not establish cause and effect. It also relied on participants reporting their age at menopause rather than researchers measuring oestrogen levels.
Most participants were of white European descent, meaning the findings may not apply to people from other racial or ethnic groups.
Wide pulse pressure is an independent risk factor for cardiovascular disease, dementia and kidney disease, according to the researchers, although pulse pressure is not currently included in clinical guidelines for managing blood pressure.
Mitchell said healthcare professionals should consider pulse pressure when assessing middle-aged and older people with high blood pressure, particularly women.
Samar R. El Khoudary, who was not involved in the study, said the findings did not mean menopause had no role in women’s cardiovascular health.
“Vascular aging may begin years before menopause, but that doesn’t mean menopause is irrelevant. The trajectory may accelerate as women enter perimenopause.
“We shouldn’t wait until menopause to start thinking about cardiovascular health.
“By the time a woman reaches her final menstrual period, vascular changes may already have been underway for years. Midlife is an opportunity to identify cardiovascular risk early and intervene before disease develops.”
