Regulation of postmenopausal hypertension

Menopause, the cessation of menstrual cycling, is associated with an increase in risk for cardiovascular diseases, including hypertension. Currently, the average age of menopause is 51 and studies have found that the risk factors for postmenopausal diseases begin to develop during perimenopause, the 5- to 10-year period preceding the onset of menopause. Clinical studies have demonstrated that only 36% of postmenopausal women with hypertension have their blood pressure under control, despite taking antihypertensives. Women taking a monotherapy of a beta-blocker, an Angiotensin-converting enzyme (ACE) inhibitor, or a calcium channel blocker are less likely to have their blood pressure under control than women who take a diuretic alone. Discrepancies in disease pathology between pre- and postmenopausal women, and the cause of the reduced effectiveness of the major antihypertensive therapeutics remain unclear. This chapter highlights recent developments in our understanding of postmenopausal hypertension, including potential mechanistic pathways that may provide new treatment paradigms, including the activation of immune cells and inflammatory pathways in the postmenopausal kidney and vasculature.