Hypertension in postmenopausal women. Role of androgens

Abstract

In Argentina, one in four women die from cardiovascular disease (28%), being responsible for 46% of postmenopausal women's deaths worldwide. Hypertension (HTN) is the cardiovascular risk factor most related to mortality in this female population. From birth to menopause, women appear to be protected from cardiovascular events compared to age-matched men. This protection occurs most often during the fertile age of a woman, where estrogen would play an important protective role against cardiovascular events. Subsequently, during post-menopause, women equal and may exceed the prevalence of HTN and cardiovascular events. However, the cause of this difference between men and women still needs to be elucidated. Different theories highlight the protective role of estrogen; however, androgens may contribute to increased blood pressure after menopause. In this period, women would increase androgen levels by up to four-fold while reducing estrogen levels. The imbalance between androgens and estrogens would induce vascular, renal, cardiac, and brain functional and structural changes, which would contribute to the above. This review highlights the role of androgens as a possible causal factor for postmenopausal hypertension and discusses possible mechanisms that would participate in this process.