Department of Medicine, University of Padova, Padova, Italy.
Studium Patavinum, University of Padova, Padova, Italy.
J Hum Hypertens. 2019 Jun;33(6):421-428. doi: 10.1038/s41371-019-0194-y. Epub 2019 Mar 21.
In affluent societies blood pressure increases with age from early life to the eighth decade with sex differences. Before middle age, lower blood pressure values are observed in women than in coeval men, whereas the reverse seems to occur thereafter. Menopause is considered the major determinant of blood pressure rise in women. If this hypothesis is well-founded, menopause can be regarded as one of the main cardiovascular risk factors, involving more than half of the human population, as well as the most ineluctable. In industrialized countries, age at menopause ranges between 50 and 52 years. The popular message is that fertile women are protected from cardiovascular risk by circulating estrogens, a privilege that is lost when postmenopausal women become not different from men from the point of view of risk factors and cardiovascular events. Nevertheless, the hypothesis that menopause or the estrogen decrease are per se associated to blood pressure increase is still under debate. Indeed, the epidemiological challenge is due to the coincidence between advancing menopause and aging, and also to the evidence that both menopause and blood pressure have common determinants such as body mass index, diet, smoking, and socio-economic class. The strongest doubt is whether menopause is a dependent or independent risk factor for high BP, i.e. whether its action on blood pressure-if any-is due directly to estrogen fall or to other indirect factors.
在富裕社会中，血压从生命早期到第八个十年会随着年龄的增长而升高，并且存在性别差异。在中年之前，女性的血压值低于同年龄段的男性，而此后情况似乎相反。绝经被认为是女性血压升高的主要决定因素。如果这一假设成立，那么绝经可以被视为主要心血管危险因素之一，涉及到超过一半的人口，而且是最不可避免的因素之一。在工业化国家，绝经年龄在 50 至 52 岁之间。普遍的观点是，循环雌激素使生育期女性免受心血管风险的影响，而当绝经后女性在危险因素和心血管事件方面与男性没有区别时，这种特权就会丧失。然而，绝经或雌激素减少本身与血压升高相关的假设仍存在争议。事实上，流行病学的挑战源于绝经和衰老的同时发生，以及绝经和血压具有共同决定因素，如体重指数、饮食、吸烟和社会经济阶层。最大的疑问是绝经是否是高血压的一个依赖或独立的危险因素，即它对血压的作用（如果有的话）是否直接归因于雌激素下降或其他间接因素。
