Blood pressure and its link to menopause

Menopause is the biological process of the end of the menstrual cycle of a woman. It occurs due to a natural decline in reproductive hormones when a woman reaches her 40s or 50s. Menopause leads to hormonal and biological changes in the body including weight gain and hot flashes. Alongside these, it also raises the risk of heart conditions such as atrial fibrillation (abnormal heart rhythm) and high blood pressure.
 
Menopause, a heart disease risk
 The level of estrogen, the hormone which plays a crucial role in overall health, declines following menopause. Low estrogen levels impact the flow of blood and the heart needs to pump harder to ensure proper blood circulation, leading to increased blood pressure. This in turn strains the heart.

Increasing age and declining metabolism mostly leads to women becoming less active. This coupled with weight gain contributes to high blood pressure leading to heart diseases.

Apart from this, menopausal women are sensitive to salt and excessive sodium in the body can lead to water retention, thereby creating pressure on the blood vessels.

Warning signs of high blood pressure in menopausal women

Following symptoms should not be ignored in menopausal women as they may be an indication of high blood pressure:

• Palpitations in the heart

• Family history of heart disease

• Lightheadedness or dizziness

• Diabetic or high cholesterol levels
• Obstructive sleep apnea (sleep disorder in which breathing repeatedly stops and starts)

Preventive measures

• Monitor weight fluctuations and blood pressure

• Consume healthy and balanced diet rich in fruits, vegetables and whole grains

• Increase consumption of dairy products such as milk, yogurt and cheese to ensure adequate intake of calcium, phosphorus, potassium, magnesium and vitamins D and K

• Reduce intake of processed food and salt

• Get 150 minutes of exercise in a week

• Do not smoke, and avoid alcohol and caffeine

Keep stress in check

While it is necessary to maintain a healthy lifestyle to keep blood pressure levels in control, one should undergo regular health check-ups for prevention. Women with high blood pressure should create a personalised plan with their doctor to include diet, exercise and other lifestyle changes to keep blood pressure and heart disease in check.


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Why high blood pressure is misdiagnosed 40% of the time

Hypertension, or simply high blood pressure, is one of the most common cardiovascular conditions, affecting a wide range of people all over the world. According to the National Health Portal of India, one in every five adults suffers from high blood pressure. However, due to the absence of any apparent symptoms, it is often ignored and/or misdiagnosed. Estimates suggest that 50% of patients don’t even know they have hypertension.

Recent reports by the India Heart study (IHS), the nation’s biggest study focusing on the importance of home-based blood pressure monitoring, now show that hypertension misdiagnosis is much more common than anticipated in India. This severely worsens the prognosis of hypertensive patients - high blood pressure is the most common cause of heart diseases and stroke.

What is hypertension?

Blood pressure is the force your blood puts on blood vessel walls while it's flowing through the body. It is measured in mm of mercury: mm Hg. A blood pressure reading of more than 140 mm Hg systolic pressure (denoted by the upper number) and 90 mm Hg diastolic (lower number) is considered hypertension.

Hypertension can be caused due to several factors like unhealthy lifestyle, stress, obesity, and genetics. Growing older, excessive salt intake and secondary conditions like diabetes increase the risk of hypertension. Interestingly, men are more prone to high blood pressure than women. However, regardless of the cause, most hypertensive people don’t really show any apparent symptoms.

Uncontrolled blood pressure may manifest in the form of headache, fatigue, confusion, breathing difficulties, chest pain, palpitations and hematuria (blood in urine). In serious cases, it can lead to complications such as coronary heart disease, heart attack, and chronic kidney failure. High blood pressure is responsible for about 10.8% of deaths in India, as per the Indian Council of Medical Research.

Regular monitoring of blood pressure is important if you fall in any of the high-risk categories.

Difficulties in diagnosis

Hypertension is mainly diagnosed through a sphygmomanometer (blood pressure machine) reading. Sphygmo means “related to pulse”, and a manometer is a device to measure pressure.

However, your blood pressure can rise due to anxiety when you visit the doctor - this condition is known as whitecoat hypertension and it increases the chances of misdiagnosis.

On the other hand, some people have masked hypertension. It is a condition in which a hypertensive patient shows normal blood pressure readings at a doctor’s clinic but high blood pressure at home. According to the University of Wisconsin Hospitals and Clinics Authority, U.S., masked hypertension is seen more commonly in men, alcoholics, tobacco users and people who live in an otherwise stressful environment. Such people show normal blood pressure readings at the doctor’s office but have high blood pressure soon after they go back to their everyday work.

In the IHS study, lead investigator  explained that whitecoat hypertension and masked hypertension lead to misdiagnosis in about 40% of cases in India.

Due to these conditions, non-hypertensive people end up being prescribed with blood pressure-lowering medications. On the other hand, people suffering from high blood pressure go without treatment.

Furthermore, he added that Indians have a much higher resting heart rate - 80 beats per minute compared with 72 beats per minute in the West. Blood pressure readings in most Indian patients are noted to be much higher in the evenings than during the morning. Clearly, there is a need to reconsider the right timing for the administration of anti-hypertensive drugs for Indians.

For accuracy of diagnosis, doctors already suggest that at least three different readings should be taken at the clinic.

Treatment

Hypertension can’t be cured completely but it is manageable with a combination of anti-hypertensive medications and healthy lifestyle and dietary habits. Drugs like beta-blockers, ACE inhibitors and diuretics are given to avoid hypertension complications. Lifestyle habits like quitting smoking, weight management, reducing stress, regular exercise and a DASH diet (Dietary Approach to Stop Hypertension) are generally recommended.

It is important to seek medical support if you are suffering from hypertension. Timely and prompt diagnosis may go a long way in promoting longevity and improving the quality of life.

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Is salt a villain?

Salt is responsible for 2.3 million deaths globally, says a study released by Harvard School of Public Health. One in ten dies from a heart attack, stroke or some cardiovascular disease as a result of eating too much sodium, according to the study.

Salt is a hard habit to shake off. It is a basic taste, and if there are people with a sweet tooth, then there are some who crave salt. When we sweat or vomit, our sodium levels decrease and we get a salt appetite. Research suggests stress can make us reach for the salt shaker, leading to a salt-habit. We consume salt indirectly through processed/canned items where it is a preservative.

Is salt a villain? The sodium and chlorine in common salt are essential to maintain the fluid balance in our body and for normal cellular functions, says Dr. Priya Chockalingam, cardiac wellness physician. Also called electrolytes, they carry an electric charge and move in and out of our cells to provide energy for muscle/nerve/brain/heart cells to work. The normal sodium level in our body is 135-145 millimoles per litre of blood; too much (hypernatremia) or too little (hyponatremia) of it can cause cells to malfunction and extremes can even be lethal.

Less and more

Both increased and decreased intake of common salt can affect us, warns Dr. Y V C Reddy, Senior Consultant Cardiologist (Apollo Main). “Salt intake should be less in patients with hypertension and heart failure, where increased salt intake can cause fluid accumulation, increase blood volume and BP, and worsen breathing difficulty. In patients prone to hyponatremia, decreased salt intake can precipitate low-sodium problems.”

How much salt is too much? More than 4-6 grams/day is excess for a normal individual, he says. Patients with heart or kidney problems should reduce it to the minimum. No, we can’t avoid it completely. “Hyponatremia or low sodium in serum in certain patients can lead to seizures, brain damage, even death.” Aren't some people unaffected by excess salt intake? “Our homeostatic mechanisms can keep blood-sodium levels optimal despite a lot of dietary salt intake,” he agrees, but “if you are a salt-sensitive, hypertensive person, excess salt is bad.”

Salt-BP nexus

Dr. Priya explains the salt-BP nexus. If the sodium level in the blood is more than normal, our body tries to neutralize that by increasing the water level in the blood (makes us thirsty to drink water, and kidneys restrict excretion), eventually bringing the sodium concentration to normal again. In this process, the circulating fluid level has increased, and this in turn increases the BP level. Apart from too much salt, being physically inactive, being overweight, excessive alcohol consumption and family history are risk factors.

What of potassium salt? Potassium salt can be used as a substitute in normal individuals, says Dr. Reddy. But for patients prone to hyperkalemia (too much potassium in the blood) this option is closed. Eating potassium-rich items such as bananas, tomatoes and low-fat dairy products has a heart-healthy effect, because it helps the kidneys remove excess sodium from our body, says Dr. Priya. So restrict the use of salt in cooking, have a lot of potassium-rich natural foods to keep BP under control.

Our love for processed items has left us getting much more sodium than required, says Dr. Priya. Our perception of taste has changed and we try to add more salt in our daily cooking. Fruits, vegetables, meat and seafood also contain sodium. Apart from the salt, processed items have baking powder, flavour enhancers and preservatives that contain a lot of sodium. “Salt is an integral part of our lives. But it is certainly a double-edged sword. We need strict balance since both too much and too less can be harmful.”

Some pointers on salt intake

WHO recommends limiting sodium to less than 2,000 mg/day.

American Heart Association recommends 1,500 mg/day. (One teaspoon of salt has 2,325 mg of sodium.)

Hence, keep intake of processed and tinned items to a minimum.

Avoid pickles.

Eat wholesome items like fruits, vegetables, lean meats and beans to satisfy your craving for salt.

Minimise the use of added salt in curd and salad. Remove the salt shaker from your dining table.

ps- this is only for information, always consult you physician before having any particular food/ medication/exercise/other remedies.

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