Contradicting the long-held belief that menopause drives an increase in aortic stiffness in women, new research from the Framingham Heart Study indicates that the change in pulse pressure—the difference between systolic and diastolic blood pressure readings—begins about two decades before menopause. The study, published in the American Heart Association journal Hypertension, analyzed data from 6,760 women and 3,248 men and found that pulse pressure reached its lowest point and began rising in women in their late 30s, compared to late 40s in men. The timing of menopause had no influence on this transition.
“Many people believe that the change in pulse pressure is linked to the hormonal shifts caused by menopause. Here, we are evaluating whether the timing of this change, from falling to rising pulse pressure, is connected to menopause timing in a long-term study,” said study senior author Gary F. Mitchell, M.D., a longstanding NIH-funded investigator with the Framingham Heart Study and president of Cardiovascular Engineering, Inc.
The aorta, the body’s largest blood vessel, stiffens with age, and pulse pressure widens as a result. A wider pulse pressure means the heart works harder and can damage small vessels in organs like the brain and kidneys. Women start with fewer elastic fibers in the aorta, so their pulse pressure becomes higher than men’s after midlife. The study found that after age 60, average pulse pressure was higher in women than in men.
Wide pulse pressure is a major risk factor for cardiovascular disease, dementia, and kidney disease, and it may make high blood pressure less responsive to some medications. However, pulse pressure is not currently included in clinical guidelines for managing blood pressure. “Healthcare professionals should definitely consider pulse pressure in middle-aged and older patients – especially women – with high blood pressure,” Mitchell said. He advised that women and their doctors should sound the alarm if pulse pressure is higher than 60 mm Hg, such as 130/70 mm Hg, and track it over time.
Samar R. El Khoudary, Ph.D., M.P.H., FAHA, who chaired the writing group for a 2020 American Heart Association scientific statement on the menopause transition, noted that vascular aging may begin years before menopause. “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.”
The study’s limitations include its observational design, reliance on self-reported menopause age, and a predominantly white European descent sample. The research was supported by the National Heart, Lung, and Blood Institute and led by Boston University since 1971. The findings suggest that healthcare providers should pay greater attention to pulse pressure in women, as it may signal early vascular aging and increased risk for heart disease, dementia, and kidney disease.
