Women, hormones and blood pressure

Raised blood pressure is an important risk factor for both coronary artery disease and stroke in women. In terms of exogenous sex hormones, use of premenopausal oral contraceptives has been consistently associated with higher blood pressure levels; both estrogenic and progestogenic components have been implicated. In contrast, a randomized trial has shown no effect of post-menopausal hormone use on blood pressure. Observational studies indicate a protective effect of postmenopausal estrogen use on coronary artery disease. This is probably largely mediated through effects on lipoproteins and not blood pressure; data on post-menopausal estrogen use and stroke risk are less consistent. Treatment trials have demonstrated beneficial effects of lowering blood pressure on cardiovascular disease, particularly regarding stroke in women. The women most likely to benefit from individually-based clinical preventive interventions for cardiovascular disease, such as hypertension treatment or estrogen replacement therapy, are women who have high absolute risk of cardiovascular disease, ie, older women with high risk factor levels with a family or existing history of cardiovascular disease. Nevertheless, the large international variation in rates of cardiovascular disease indicate the large potential for prevention and suggest that most women are likely to benefit from lifestyles conducive to cardiovascular health, that is increasing physical activity, not smoking and following diets low in sodium and saturated fat and high in fruits and vegetables.