Aortic Stiffness May Drive Midlife Pulse Pressure Rise in Women, Not Menopause

A new study published in Hypertension, a peer-reviewed journal of the American Heart Association, indicates that the midlife rise in pulse pressure and aortic stiffness in women may not be primarily driven by menopause. The research, based on data from the long-running Framingham Heart Study, found that pulse pressure begins to increase about two decades before the final menstrual period, suggesting that vascular aging starts much earlier than previously thought. This finding has significant implications for how healthcare professionals assess and manage cardiovascular risk in women.

Pulse pressure, the difference between systolic and diastolic blood pressure readings, is a marker of aortic stiffness. A wider pulse pressure indicates that the aorta is becoming less flexible, which increases the risk of heart disease, dementia, and kidney disease. The study analyzed data from 6,760 women and 3,248 men across three health visits spanning 14 years. Researchers discovered that pulse pressure reached its lowest point and began to rise in women in their late 30s, compared to late 40s in men. Importantly, the timing of menopause—whether early, average, or late—had no influence on when this transition occurred.

“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 senior author Gary F. Mitchell, M.D. The results, he noted, were surprising: “To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife.”

The study’s findings underscore the importance of monitoring pulse pressure in middle-aged and older adults, especially women. “Healthcare professionals should definitely consider pulse pressure in middle-aged and older patients – especially women – with high blood pressure,” Mitchell said. He advised that a pulse pressure higher than 60 mm Hg, such as 130/70 mm Hg, should prompt concern and regular tracking. Wide pulse pressure is also less responsive to standard blood pressure medications, making tailored treatment essential.

Samar R. El Khoudary, Ph.D., M.P.H., FAHA, who was not involved in the study, emphasized that cardiovascular health should be a focus long 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,” she said. El Khoudary chaired the writing group for a 2020 American Heart Association scientific statement on the menopause transition.

The study has limitations, including its observational design, reliance on self-reported menopause age, and a predominantly white European descent participant pool, which may limit generalizability. However, the implications are clear: vascular aging in women may begin years before menopause, and midlife presents a critical window for early intervention. The American Heart Association provides resources on menopause and heart health to help women and healthcare professionals address these risks.