The Unique Relationship Of Hypertension In Women

Illustration of a blood pressure measuring device (Photo: Antara)

JAKARTA - The relationship between hypertension in women is said to be unique as there are various hormonal changes that occur throughout their life cycle from childhood to old age, said Member of the Indonesian Society of Hypertension (InaSH) Consensus Guide Working Group, dr. Siska Suridanda Dany, Sp.JP, FIHA.

In each phase, there are gender-specific changes that can put women at risk for hypertension and the complications that come with it. In the childhood and adolescent phase, hypertension can occur generally due to organ disorders with manifestations of increased blood pressure leading to kidney and blood vessel damage.

Entering young adulthood, changes that affect hypertension in women begin to appear. Reproductive age and the possibility of pregnancy and the consumption of hormonal contraceptives are risk factors for hypertension in this age group.

When women are pregnant, hypertension is one of the things that needs to be watched out for because it is found in about 10 percent of pregnancies and ranks second as a contributor to maternal mortality in developing countries.

The risk of developing hypertension during pregnancy is generally the age of the mother who is very young or old (40 years), the mother-to-be who has a previous history of hypertension, diabetes, obesity, multiple pregnancies and a history of diseases such as kidney and autoimmune disease.

Hypertension in pregnancy is broadly divided into two, namely mothers with previous chronic hypertension and without previous hypertension. Both increase the risk of complications in the mother.

Pregnancy-induced hypertension only appears after 20 weeks of gestation and the mother's blood pressure will decrease after she gives birth. Meanwhile, chronic hypertension will continue to increase after birth.

Hypertension in pregnant women is at risk of causing them to develop serious neurological disorders such as seizures, stroke, kidney failure, blood clotting disorders, heart failure and death. In infants, maternal hypertension is at risk of causing growth disorders, premature birth and stillbirth.

According to Siska, the management of hypertension and its complications in pregnancy must consider the hormonal changes that occur and the conditions of pregnancy. This can lead to limitations of anti-hypertensive therapy that can be given.

In addition, he views it is important for pregnant women to undergo regular blood pressure checks during pregnancy control, do regular exercise, adopt a healthy diet including low salt, fat and maintain body weight according to gestational age.

Those who delay pregnancy for various reasons, one of which is not feeling ready, and decide to use hormonal contraceptive drugs, cannot be separated from the risk of developing hypertension. The use of hormonal contraceptive drugs is one of the gender-specific aspects of increasing blood pressure.

Contraceptive pill-related hypertension is found in about 2-5 percent of women with initially normal blood pressure, while in hypertensive women, an increase in blood pressure occurs in 9-16 percent of contraceptive pill users.

The risk of hypertension is related to the dose and type of contraception used, smoking habits, age, family history of hypertension, and obesity.

"Therefore, if you want to use hormonal contraceptives, you should be aware that an increase in blood pressure is one of the things that can lead to complications and blood pressure must be checked before and after taking contraceptive pills every 3 months," Siska advised, quoted from Antara, Saturday.

Women can change the type of contraceptive drug if an increase in blood pressure occurs, according to the results of consultation with a doctor. Currently, there are several types of hormonal contraceptives that are known to have a lower risk of developing hypertension compared to other options.

Generally, this increase in blood pressure will return to normal when the contraceptive pill is discontinued. If the blood pressure remains high despite adjustments to the contraceptive pill type, the contraceptive pill should be discontinued.

Furthermore, entering menopause is a crucial phase for women due to drastic hormonal changes which generally increase blood pressure, heart and blood vessel disease.

The hormone estrogen, which plays an important role in relaxing blood vessels and regulating blood pressure, levels will decrease. This leads to impaired relaxation and increased stiffness of blood vessels, increased sensitivity to salt, weight gain, changes in fat metabolism and constriction of blood vessels.

"As age increases further, the risk of organ complications due to increased blood pressure is getting higher and higher," said Siska.

In women, in addition to increasing age which increases the risk of hypertension, hormonal changes throughout the life cycle make its relationship with hypertension a unique relationship.

Chairman of the Indonesian Society of Hypertension (InaSH), dr. Erwinanto, Sp.JP(K), FIHA, said that in general the prevalence of hypertension in Indonesia based on the 2018 survey was around 34 percent, unchanged from the figures obtained in the 2007 survey. The cause of the high new cases of hypertension is due to high risk factors for hypertension such as diabetes. mellitus (diabetes), obesity, high salt consumption and smoking.

Furthermore, according to Erwinanto, those with hypertension who take medication and have their blood pressure controlled in Indonesia are still low. The May Measurement Month survey noted that about 37 percent of those taking medication had controlled blood pressure or less than 140/90 mmHg.

For hypertensive patients, achieving controlled blood pressure is important. Secretary General of the Indonesian Society of Hypertension (InaSH), dr. Djoko Wibisono, Sp, PD-KGH, said that long-term controlled blood pressure conditions can prevent organ damage caused by hypertension or Hypertension - Mediated Organ Damage (HMOD) such as stroke, heart attack and kidney damage that can lead to death."​​​​