Hypertension is a health issue which is mostly associated with men and, as such, women are considered safe from its development. However, this myth has been disrupted following various researches that reveal that HBP is not a gender issue affecting both men and women. However, men were found to be more susceptible to developing the illness than compared to women. In this regard, women were also found prone to developing the ailment on the basis of various factors that will be discussed in this paper. In addition, this paper will focus on hypertension in women and the clinical studies and guidelines composed from various studies one of them being Women’s Health Initiative (WHI) and the compilation of past and present best practices in dealing with hypertension in women.
Hypertension
According to Rosenfeld (2009), hypertension occurs when the force of blood being pumped in the body pushes hard against the delicate inside wall or lining of the arteries. In this instance, if the high force of blood persists for a longer period of time than what is considered normal, Hypertension develops. This condition can cause adverse damage to body organs such as the heart, brain, and blood vessels.
Approximately one in three Americans is affected by hypertension. As indicated above, the previous notion of hypertension being a male problem has been replaced by new evidence that prove that both women and men from the age of forty years experience the same level of risk of developing hypertension in their lifetimes. More specifically, women who are post-menopausal experience even higher levels of risk than compared to men.
Owing to its lack of evident symptoms, hypotension is referred to as a silent killer. Unless one is keen, development of the ailment can catch one unaware leading to adverse consequences such as heart attack and stroke. Some common symptoms for those with severe hypertension include persistent headaches, frequent nosebleeds, or dizziness.
During childbearing years, women who take birth control pills may experience elevated levels of HBP. This situation mostly happens to women with past and family history of hypertension, or the women are overweight. The most effective techniques of preventing hypertension for both men and women include frequent exercise, adoption of healthy eating habits and diets with low saturated fats and caloric content, and continuous monitoring of one’s HBP levels.
Women’s Health Initiative
The Women’s Health Initiative (WHI) is a complex and large clinical investigation whose main intention is to propose strategies meant to control and prevent the underlying causes for the high rates of morbidity among post-menopausal women (87. In this case, this investigation intends on resolving ailments surrounding Cardio-Vascular Diseases (CVD), cancer, and osteoporotic fractures. The WHI focuses on randomized preventive clinical trials that are sponsored by the federal government focused on assessment and management of these ailments. This trial encompassed the involvement of women who used both estrogen and medroxyprogesterone acetate, that is, synthetic progestin, every day. This trial became the largest initiative of women who used Hormone Therapy (HT). In addition, the trial comprised of three other groups, namely, a lifestyle and diet group, an estrogen-only group and a sugar pill or placebo group. The WHI study involved women between the ages of 50 and 79. From this group, the majority of women participating in the study were between 60-69 years old.
The determination of a randomized trial was based on the fact that this approach is considered to be the best, or rather, achieves a gold standard in terms of medical studies. This approach is undertaken to determine the existence of any bias from observational studies exists. The study was carried out with the intention to ascertain the hypothesis that indicated that women who were assigned randomly to HRT had lower rates of Cardio-Vascular Diseases and osteoporotic fractures than those compared to the placebo group.
The results from the Hormone Therapy proposed by WHI apply to women who are more than 63 years of age and have experienced menopause recently (Rosenfeld, 2009). This situation is as a result of the realization from both Estrogen Therapy (ET) and Hormone Therapy (HT) which indicates that the risk associated with CHD might develop from the onset of the treatment period.
The choice of progestin alters the effects of cardiovascular considerations of both HT and ET. In this instance, despite synthetic medroxyprogesterone being vaso-constrictive in nature, the application of natural progesterone in place of it is recognized to have vaso-relaxing effects. As such, the latter is identified to have only a salutary impact on blood pressure and therefore provides the best alternative to be considered in the procedure.
The impact of ET immediately after some procedures on women such as oopherectomy is associated with low prevalence rates of coronary artery calcium than compared to those who do not take up the procedure after the above procedure is carried out.
Clinical Practice
The results from the Randomized Control Testing (RCT) carried out by WHI were greatly opposed following the conduct of the research. In spite of the accuracy illustrated by the research design, researchers indicate that the study population was flawed following the lack of adequate representation to provide conclusive findings. As such, the results from the research were not representative of the rest of the target population which was women in their post-menopausal incidence period. In this regard, findings from the WHI study indicated that there was increased risk as a result of the close association with estrogen for women who were in this category.
The WHI discredits the application of HRT as a strategy to control hypertension in women as a result of increased risk in consideration of Cardio Vascular Diseases. This aspect differs from observational studies which ascertain the positive outcomes of the application of both HT and ET in such instances. This difference is accounted by the bias aspect evident in observational studies. In this regard, selection bias that is based on health and social considerations play a critical factor in the determination of the results. In this regard, as per the observational study, women who participated in the HT were considered to be generally more healthier, affluent, and better educated than compared to those who do participate in HT.
According to Waldum, Stenehjem, Os, Hoieggen, and Gudmundsdottir (2012), lifestyle considerations are imperative in assessing and managing the disorder. In this case, the guidelines meant to treat hypertension are the same irrespective of gender considerations. The emphasis of lifestyle changes alone is considered to be worse in women than compared to men. This situation is as a result of the difficulty in weight loss experienced in women than compared to men. In response to lifestyle modifications, as a result of results that reveal the presence of low plasma renin in women who are hypertensive, the aspect of low salt intake is considered paramount. This situation is as a result of the Dietary Approaches to Stop Hypertension (DASH) which prove that dietary sodium is directly related to high blood pressure. Furthermore, other large-scale trials that investigate the aspect of antihypertensive treatment focus on the efficacy of pharmacological agents as well as dietary considerations.
The difference inherent between the current best practices and those suggested by WHI is based on the fact that WHI Hormone Therapy does not reduce hypertension and as such should not form the primary treatment option and also should not be prescribed for either primary or secondary Cardio-Vascular Disease prevention. This difference accounts for the proper management of CVD among women, thereby reducing their prevalence and susceptibility to being prone to the development of these illnesses.
The current best practices as suggested by Waldum et al. (2012) are applicable in clinical settings. In this case, the emphasis of lifestyle modifications as a primary strategy of effectively managing and treating hypertension in women is relevant to health practices. In this case, dietary considerations are recognized as one of the underlying causes of weight gain, an aspect closely associated with hypertension. Therefore, proper and healthy diets with low caloric and sodium content as well as regular physical exercises will effectively manage weight gain and hence improve the management of HBD in women.
Conclusion
Current best practices surrounding hypertension in women can be effectively incorporated to manage and treat the ailment. The dispersal of the myth of hypertension being a ‘man’s disease’ has led to the realization of the risk posed by the illness especially for post-menopausal women. In this regard, adoption of proper lifestyle considerations is recognized as an effective option to manage hypertension.
Reference
Rosenfeld, J. A. (2009). Handbook of women's health. Cambridge: Cambridge University Press.
Waldum, B., Stenehjem, A., Os, I., Hoieggen, A. & Gudmundsdottir, H. (2012). Hypertension in women: Latest findings and clinical implications. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513905/
