Menopause-Related Trajectories of Blood Pressure in Midlife

taking blood pressure
taking blood pressure
Investigators sought to determine if the menopause transition affects the trajectory of women’s blood pressure.

A group-based trajectory modeling study showed that the menopause transition affects systolic blood pressure (BP), pulse pressure, and mean arterial pressure (MAP), revealing distinct BP trajectories in certain groups of women in midlife. These findings were published in Circulation Research.

This study included 3302 participants from the Study of Women’s Health Across the Nation (SWAN), an ongoing multi-ethnic, multi-site longitudinal cohort study, which includes women aged between 42 to 52 years and recruited between 1996 and 1997 from 7 sites (Detroit, Michigan; Boston, Massachusetts; Chicago, Illinois; Oakland, California; Los Angeles, California; Newark, New Jersey; and Pittsburgh, Pennsylvania). Utilizing group-based trajectory modeling, relative to menopause onset, participants who shared distinct BP trajectories over time were classified into low, medium, or high trajectory groups for each measure of systolic BP, pulse pressure, and MAP in order to assess associations of menopause-related factors with trajectory group or level of BP measures.

Researchers found that the low systolic BP, pulse pressure, and MAP trajectories were rising gradually before menopause, but reflected a substantial accelerated rise 1 year after menopause. The low systolic BP, pulse pressure, and MAP trajectories were also predicted by a younger menopause age. Researchers also found that a greater follicle-stimulating hormone (FSH) level predicted lower systolic BP and pulse pressure levels. The occurrence of vasomotor symptoms — such as night sweats and hot flashes — predicted higher systolic BP, pulse pressure, and MAP levels over time.

Researchers noted study limitations: they did not observe the final menstrual period in 41% of women and the group-based trajectory modeling does not account for this group in determining BP trajectories; a 28% attrition rate was present; conclusions related to pulse pressure trajectories were limited due to small cell count in some groups; temporal associations between menopause transition and BP do not imply causal relationships; and their findings are hypothesis generating and susceptible to type I error.

“Distinct BP trajectories over the [menopause transition] exist that revealed a group of women whose [systolic] BP, [pulse pressure], and MAP trajectories are consistent with a menopause contribution. Our findings support frequent monitoring of BP during the [menopause transition],” the researchers stated.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Samargandy S, Matthews KA, Brooks MM, et al. Trajectories of blood pressure in midlife women: does menopause matter? Circ Res. Published online January 6, 2022. doi:10.1161/CIRCRESAHA.121.319424