The biggest killer of women is heart disease and stroke: Reducing your risk of high blood pressure (Hypertension)
- Dr Natalie Hutchins
- Mar 7
- 9 min read
Vascular disease (including heart attacks and strokes) is the biggest killer in women worldwide. Anyone with an interest in living as healthy a life as possible (free from disease and disability), for as long as possible, needs to have these diseases in mind as a top priority.
In this series, we explore some of the contributing factors to women’s biggest causes of death and disability as they age.
High blood pressure (Hypertension)
Why is high blood pressure important?
The development of high blood pressure is a huge risk factor for vascular disease, which includes heart disease, strokes, dementia, overall cognitive decline and kidney disease; the main causes for death and disability for us all.
50% of people with high blood pressure do not realise they have it; hence it being called ‘the silent killer’. Simply listening to your body (I do think this is important), unfortunately won’t do. It usually has no symptoms until it is very severe, by which point you will often already have complications from it. The only way to catch it early is to proactively monitor it.
What does the term high blood pressure actually mean?
It’s a measure of how much force is exerted against the walls of your blood vessels with each heartbeat from the blood flow within them. We need some blood pressure to make sure blood reaches all the important organs, regardless of how far they are from the heart.
But we don’t want it to go too high as that force can lead to damage of the arteries and lead to plaque buildup and cause stiffening of the artery walls (healthy arteries have some elasticity so give a little under pressure). This in turn worsens the situation as the stiffer the arteries are and the more plaque they have, the narrower they are, resulting in more resistance to blood flow. This puts additional strain on the heart, which now needs to contract with more force.
What are the other consequences of high blood pressure?
1. Stroke:
This is the term used to describe an event in the brain that causes reduced oxygen supply and damage of an area supplied by a particular vessel. The event can either be plaque rupture in an artery leading to an ischaemic stroke (that means ‘inadequate blood supply’). Or rupture of the blood vessel itself causing a brain haemorrhage. High blood pressure can increase the risk of both of these types of stroke.
2. Vascular dementia and cognitive decline:
Damage to the larger arteries of the brain can lead to strokes but when the damage occurs in the smaller vessels, this can cause tiny areas of the brain to lose their blood supply. This may not produce noticeable differences in the way you function day to day, but over time, more and more damage can lead to small changes in your memory and cognition. Once this reaches a critical point, we then refer to it as vascular dementia.
3. Kidney disease:
The arteries of the kidneys are small and fragile, and like those in the brain, cannot withstand chronic elevations in blood pressure without becoming damaged. This causes a slow but steady decline in kidney function. On top of that, the main arteries into the kidneys can also have a buildup of plaque and because blood flow in the kidneys helps regulate the blood pressure, exacerbates the situation even more.
4. Heart disease:
Plaque buildup in the coronary arteries can cause poor blood flow to the heart muscle. When this happens it can cause angina, (chest pain due to poor blood flow to the heart) and if the plaque ruptures, it can cause a heart attack. As mentioned above earlier, the additional strain on the heart due to the increased resistance in the vascular system, can lead to heart failure if not addressed early enough.
Sounds scary….
Yes, but understanding the risks of high blood pressure and how and why they develop, can really help take it from something that has no symptoms and is therefore quite abstract, and make its importance more tangible. And while it sounds scary, you have to remember that this has the potential to be prevented if we are proactive and focus on optimising our blood pressure early rather than waiting to just treat it. Even if you have established high blood pressure, there is always something you can do about it.
What causes the blood pressure to become high in the first place?
The exact reason isn’t fully understood but we know that there is an interplay between genetics and environmental factors, which affect the structure and function of the heart, vessels and kidneys.
However, we do know of many risk factors that make it more likely that your blood pressure will increase, such as age, chronic stress, overweight, smoking, a poor diet, excess alcohol, inactivity and family history.
In women we also know that having pre-eclampsia or high blood pressure in pregnancy are further independent risk factors for developing high blood pressure and this is often overlooked. Pregnancy is like a ‘stress test’ for life and can often reveal weaknesses in our health, which may go away after pregnancy, but have the potential to develop again in later life.
We also know that the menopause is a time when women’s blood pressures start to increase as our own natural oestrogens have a protective effect by relaxing the artery walls. We know that whilst HRT containing oral oestrogens can have a negative effect on blood pressure, transdermal oestrogens do not. This is due to the effect of oral oestrogen on the liver. The same is true for oral oestrogens in contraceptive pills, which can cause a blood pressure rise in some women.
I think every adult should be monitoring their blood pressure but if you have any of these risk factors, including the female specific ones, that monitoring needs to start earlier and or be more frequent.
So how do I monitor my blood pressure?
I’m sure soon enough, continuous blood pressure readings will form part of all the popular tracking devices that most of us now wear. This will be a gamechanger in terms of personalized data.
Until then, we have 3 options:
1. Buy a blood pressure monitor pictured above. You can take it into your doctors’ surgery for calibration and use this for home blood pressure monitoring. The downside to this is that you aren’t getting continuous monitoring but if done correctly a few times a day over a period of time, this does give a good estimate of your blood pressure trend.
2. There are many 24-hour blood pressure monitoring devices out there, worn as a cuff around the arm or around the wrist. It’s not something you would want to wear every day though as they are bulky, but you could use it for screening every now and then. The benefit of a 24-hour monitor is that you can see what your blood pressure trend is at night as well as in the day. Elevated blood pressure at night or a failure for your blood pressure to drop at night, is associated with a particularly increased risk of complications even if it is reasonably normal during the day.
3. Invest in an Aktiia 24-hour blood pressure monitor[1].This is a relatively new and validated wrist wearable and it’s small enough to wear all day, every day to get in depth insights into your blood pressure. The only downside, which might be a big one for some is that it’s yet another thing to wear on your wrist and it doesn’t yet integrate with any other health apps. With that said, if I had risk factors for high blood pressure or had been diagnosed with it, I think it would be a worthwhile investment and would go as far to say, that of all the variables you can track, aside from sleep, this is may be one of the most important.
What do the numbers actually mean?
The 2 numbers tell us the pressure in the arteries when the heart has contracted, systolic blood pressure, and when it is relaxed between heartbeats, diastolic blood pressure.
A systolic blood pressure between 90 and 120mmHg and a diastolic blood pressure between 60 and 80mmHg is considered normal. Levels above 140/90 have generally been considered as abnormal but most doctors with an interest in healthy ageing would agree that normal versus abnormal isn’t the best way to look it.
We know that the risk of complications from high blood pressure increases in a continual fashion as blood pressure increases. It therefore makes little sense viewing blood pressure in a dichotomous good versus bad way; it is not the case that at a systolic blood pressure of 135mmHg you have no risk i.e. good but that at 140mmHg you have all the risk i.e. bad. It makes much more sense to see it as a continuum of risk and try to optimise it based on that.
We all need enough of a blood pressure to make sure the blood gets all the way around our body, particularly to the brain, with each heartbeat, so going too low is not a good idea. But within the range of normality given above, it seems the lower you can go, the better for maintaining health.
So, if you are someone that has always had a blood pressure of 110/70, and you notice that over the years it starts creeping up to 125/85 and then 130/80, although guidelines may not identify you as having a diagnosis of hypertension, for you this is a non-reassuring trend and it might be wise to consider intervening at this point rather than waiting (intervening doesn’t necessarily mean medications).
The idea is to keep you free from disease, rather than treat the disease when it manifests.
If I have noticed a trend towards high blood pressure or it is frankly high, what should I do?
This is a great starting place for a visit to your healthcare provider for an assessment and discussion about management. You need to be thoroughly assessed for an underlying cause (often one can’t be identified but this is important especially at younger ages) and to make sure there have been no complications from it.
However, wherever that path leads you, lifestyle changes are key for everyone.
Leaving medication to the side for a moment, what can I do to reduce my blood pressure?
1. Reduce your salt intake: < 2g per day is recommended but we do need some salt. It isn’t wise to eliminate it completely as this can be associated with symptoms.
2. Supplement with potassium rich fruit and vegetables: Potatoes, bananas, beans are all rich in potassium and you could switch your regular salt for a potassium chloride salt (make sure with your doctor/ dietician that this is safe for you)
3. Change your diet: Reduce or eliminate processed foods and red meat as these are often high in salt, in addition to all the other negative effects on your overall health and start consuming a diet high in vegetables, fruits, whole grains, poultry, fish, and nuts.
4. Reduce or stop alcohol: Daily alcohol consumption significantly increases the risk of hypertension and reducing intake levels has been shown to reduce blood pressure.
5. Increase your activity levels: All forms of exercise can decrease systolic and diastolic pressure by up to 6mmHg for systolic and 4mmHg for diastolic, regardless of whether you also lose weight or not. In most of the studies showing a reduction in blood pressure, the participants were doing at least three to four sessions per week of moderate-intensity aerobic exercise lasting approximately 40 minutes over 12 weeks, so you do need to be consistent with it.
6. Incorporate techniques to reduce stress levels: Meditation, mindfulness, and guided breathing may all help decrease blood pressure, although the quality of the evidence is low and the effect size relatively modest
7. Improve your sleep: Studies have shown that sleeping for less than 5 hours a night or more than 9 hours, is associated with higher blood pressure.
8. Lose weight if needed: blood pressure tends to go down by 0.5 to 2 mmHg for every 1 kg of weight loss, so if you have overweight or obesity this is another incentive to try.
And what about medication?
There are many medications out there to treat high blood pressure and this should absolutely be considered depending on your individual circumstances. Ideally this would be done alongside lifestyle changes in every case because of the huge and far-reaching benefits of all of these changes to your overall health.
However, there are many reasons why an individual may not be able to incorporate these changes into their lives at any particular point in time and what ultimately matters to keep you well, is that your blood pressure is optimised. Remember, the possibility of stopping the medication once you are in a place to make these changes is always there and is a really great motivating aim to have.
Take aways:
· High blood pressure is an important factor in the development of disease affecting multiple organs.
· We shouldn’t see it as a good blood pressure level or a bad blood pressure level, but more as a continuum that can always be optimised.
· Optimising your blood pressure effectively requires a knowledge of blood pressure trends over time and so regular self-monitoring for all adults is key.
· Lifestyle can have a huge impact on our blood pressure and trying to optimise this is important for everyone, not just for high blood pressure but whole woman health.
· Starting medication if you can’t address your lifestyle or it doesn’t fully address the problem is not a sign of failure. Ultimately, the most important thing is that your blood pressure is optimised and not everyone will be able to do it through lifestyle alone.
External resources:
[1] This is not a sponsored affiliate link. I mention only because it is the only well validated BP wearable on the market that I have come across
