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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 206-211

To investigate the effect of age and body mass index on blood pressure in menopausal and premenopausal women


Department of Pharmacology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India

Date of Submission14-Aug-2019
Date of Decision23-Sep-2019
Date of Acceptance22-Nov-2019
Date of Web Publication25-Jan-2021

Correspondence Address:
Lokendra Sharma
Department of Pharmacology, Sawai Man Singh Medical College, Jaipur - 302 004, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_88_19

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  Abstract 


Objectives: The objective of the study is to examine the effect of age and body mass index (BMI) on blood pressure (BP) in menopausal and premenopausal women. Methods: Five hundred and thirty women between the age groups of 35 and 60 years were taken. The association between BMI and BP was measured using simple linear regression. Student's t-test was used for intragroup comparison. Results: Systolic BP (P = 0.008) and diastolic BP (P = 0.004) were slightly but significantly higher in menopausal women as compared to premenopausal women. Obesity was found to be more in menopausal women than premenopausal women (P < 0.01). Conclusion: It can be concluded that higher BMI and age lead to higher BP in menopausal women.

Keywords: Blood pressure, body mass index, menopause


How to cite this article:
Rani M, Sharma L, Sharma K, Kumar S. To investigate the effect of age and body mass index on blood pressure in menopausal and premenopausal women. CHRISMED J Health Res 2020;7:206-11

How to cite this URL:
Rani M, Sharma L, Sharma K, Kumar S. To investigate the effect of age and body mass index on blood pressure in menopausal and premenopausal women. CHRISMED J Health Res [serial online] 2020 [cited 2021 Feb 26];7:206-11. Available from: https://www.cjhr.org/text.asp?2020/7/3/206/307827




  Introduction Top


Menopause is the stage of permanent termination of menstruation due to reduction in functions of ovaries. It is associated with dormant physical activity, less energy expenditure, and alteration in fat metabolism. The imbalanced energy metabolism leads to increase in adiposity and fat accumulation.[1] Disturbed fat metabolism in menopausal women is the major cause of obesity which further imbalances hormone level and leads to various complications such as hypertension, diabetes, and hyperlipidemia.[2] Age and body mass index are major determinant of hypertension during menopausal stage.[3]

Age at menopause is an important concern because early menopause enhances the risk of many cardiovascular diseases, whereas late menopause increases the chances of breast and uterine cancer.[4] A few studies have reported an association between age and blood pressure (BP) in menopausal and premenopausal women. A study conducted by Zanchetti et al. observed that systolic BP (SBP) and diastolic BP (DBP) were higher in menopausal women.[5] Lim et al. conducted a survey in Korean menopausal women and reported that hypertension was significantly associated with age at menopause.[6] Izumi et al. observed an inverse correlation between age and BP in menopausal women.[7]

Increase in weight and BMI during menopause stage is related to metabolic syndrome and cardiovascular disease. Limited studies have been conducted to explore the effect of BMI on BP in menopausal women. Chen et al. observed a correlation between BMI and risk of hypertension in both menopausal and premenopausal women.[8] Pérez-López et al. examined the factors influencing cardiovascular system risk among postmenopausal women, such as BMI and body weight.[9] Izumi et al. observed that SBP or DBP was not significantly related to BMI.[7] Hardy et al. found no association between BMI and BP.[10]

The purpose of this study is to examine the effect of age and BMI on BP in menopausal and premenopausal women.


  Methods Top


Oversight of procedure and recruitment

The objective of the study is to investigate the effect of age and BMI on BP in menopausal and premenopausal women. The ethical approval for the study was obtained from the institutional ethics committee. Five hundred and thirty women aged between 35 and 60 years were enrolled. The willingness of participation in the survey was taken at the medical center outpatient department in written form. The women having intact ovaries, uterus, and adrenal and a history of normal menstrual cycle were only included. Those having no information regarding their age at menstruation or pregnant are excluded. On the basis of age, the participants were classified into premenopausal and menopausal women. It is important to note here that the participant was treated as menopausal women once the menses had spontaneously ceased for 12 months or more.

Data collection

Sociodemographic data, reproductive history, menstruation history, and risk factors for cardiovascular disease were collected by a researcher using a printed questionnaire which was translated into vernacular language.

Instruments used for measurement

A consistent procedure was followed while taking all the measurements.[11]

Anthropometry

  • Height (cm): It was measured using a general tape rule by standing the participant on a flat floor next to the wall
  • Weight (kg): It was measured using the standard weighting machine
  • BMI: It was calculated using the formula: body mass index (BMI): weight/height2, where the height was measured in meters and the weight was measured in kilograms. The participants were classified as underweight (<18.5 kg/m2), normal (18.5–25.0 kg/m2), overweight (26.0–30.0 kg/m2), and obese (>30.0 kg/m2) according to the standard BMI scale[12]
  • BP: It was recorded using a standard sphygmomanometer using Littmann stethoscope. A standard procedure was adopted for taking BP in sitting position. An average of two standard BP measurements was taken. The participants were segregated into hypertensive and nonhypertensive state by recording BP and comparing the values using Joint National Committee (JNC 8) guidelines.[13]


Physical activity was evaluated using a validated self-reported questionnaire.[14] All the participants were asked about the low, intermediate, and high physical activity during previous 7 days.

Statistical analysis

All statistical calculations were carried out using SPSS version 16.0 ( IBM SPSS, Chicago, IL, USA). Descriptive statistics such as mean and standard deviation of BP, age, and BMI were calculated separately for premenopausal and menopausal participants. Chi-square test was used for discrete data, whereas t-test was used for continuous data. To find correlation between BMI and BP, simple linear regression was used. Student's t-test was used for comparison of data of both the groups. Pearson's correlation was used to check the effect of age and duration of menopause on BP.


  Results Top


The present article focuses on the effect of age and BMI on BP in menopausal and premenopausal women.

The demographic and clinical features of 530 participants are shown in [Table 1]. During the study, it was to be observed that menopausal women were older and have higher SBP and DBP than premenopausal. Menopausal women tended to heavier body weight and BMI. In this study, it was found that menopausal women have less education than premenopausal due to social attitudes. Premenopausal women were more active than menopausal. Menopausal women have a higher risk for cardiovascular disease, dyslipidemia, and obesity. To examine the influence of age and BMI on BP, simple linear regression analysis was used, as shown in [Table 2].
Table 1: Baseline characteristics and clinical characters of study population

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Table 2: Comparison of age and body mass index of study population using simple linear regression at 95% confidence interval

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Few factors which influence BP in menopausal and premenopausal women are discussed in [Table 3]. A proportional relation was found between BMI and BP (menopausal and premenopausal women).
Table 3: Factors affecting blood pressure in menopausal and premenopausal women

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[Figure 1] depicts the age-wise distribution of menopausal and premenopausal women and effect of age on BP. In this study, age was significantly different in menopausal and premenopausal women. Both SBP and DBP were slightly but significantly higher in menopausal women as compared to premenopausal women. As age increased, SBP and DBP showed a tendency to be progressively increasing in menopausal and premenopausal women.
Figure 1: Effect of age on blood pressure in menopausal and premenopausal women

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In [Figure 2], menopausal and premenopausal women were categorized according to BMI. The prevalence of overweight and obesity was more in menopausal women. SBP and DBP were higher in menopausal women as compared to premenopausal women, as shown in [Figure 3].
Figure 2: Correlation between body mass index and blood pressure of study population

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Figure 3: Comparison of systolic blood pressure and diastolic blood pressure in menopausal and premenopausal women

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Age at menopause was directly correlated with SBP (r = 0.15, P = 0.01) and DBP (r = 0.14, P = 0.02), as shown in [Figure 4]a. Menopause duration of most of the women ranged from 9 to 12 years. As menopausal duration increases, both SBP and DBP increase [Figure 4]b.
Figure 4: (a) Relationship between age and systolic and diastolic pressure in menopausal women (n = 248). (b) Relationship between menopause duration and systolic and diastolic pressure (n = 248). r value symbolizes Pearson's correlation coefficient

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  Discussion Top


This study investigated the effect of BMI and age in regulating BP among menopausal and premenopausal women. Our study found the risk (odds ratios [ORs]) of developing hypertension to be significantly related to BMI and age in menopausal and premenopausal women. We observed a high prevalence of hypertension in menopausal women as compared to premenopausal women.[15],[16] BP increases as age and BMI increase in both menopausal and premenopausal women. However, increase in BP is more in menopausal women than premenopausal women. SBP and BMI were found to be higher with increasing age in menopausal women, whereas DBP increased slightly. Chaudhuri A et al. also found a similar increase in BMI and SBP in menopausal women.[17] The mechanism by which BP increases during and after menopausal stage may be due to low level of protective hormone estrogen.[18] Estrogen regulates energy balance in the hypothalamus by exerting an anabolic and lipolytic activity by regulating leptin receptors.[19] Low level of estrogen after menopause may induce an elevation in adiposity and BMI. Higher BMI in menopausal women is also due to increase in circulating insulin concentrations.[18] Cessation of menses and redistribution of sodium increase blood viscosity which may lead to hypertension.[20] The higher prevalence of treated hypertension is reported in menopausal women, particularly at age 54–60 years. However, Zanchetti et al. observed a higher prevalence of treated hypertension in menopausal women, particularly at age 46–53 years.[5]

In this study, we reported a higher risk of cardiovascular disease in menopausal women that was even more in the age group of 58–60 years. Matthews et al. study reported a higher risk of cardiovascular disease in menopausal women.[21] However, Barrett-Connor E study noticed no significant association between menopause and cardiovascular diseases.[22]

Most notably, the effect of BMI and age on OR for hypertension was higher in menopausal women, but in premenopausal women, OR was higher after 40 years. In premenopausal women, higher BMI was reported from age 40 years onward. In menopausal women, a significant increase in BMI was from age 52 years onward. As BMI increases, SBP also increases significantly in menopausal women than premenopausal women. Tan et al. conducted a study and reported that higher BMI was related to later age at menopause and higher BP.[23] The main findings of this study propose that there is a significant association between BP and menopausal status from age 52 years onward. BP and hypertension were positively and significantly associated with age and BMI. Both SBP and DBP related to age at menopause and duration of menopause. Higher age and longer menopause duration indicate higher BP and increase the prevalence of hypertension.

Strengths and limitations

This study had many limitations. First, from this study, we could not identify a cause-and-effect relationship. Second, participants recruited were healthy. Third, all data regarding reproductive health were analyzed based on a questionnaire, from which some questions were not answered by majority of women. Fourth, many other factors might contribute to the high BP such as family history of hypertension, dietary components, and genetic variations were not collected during data collection.

Nevertheless, our study had several strengths, including relatively large sample size more than 100 as compared with previous studies. Moreover, our study investigated the prevalence of hypertension in both menopausal and premenopausal women. Furthermore, the observation we have reported here that both BMI and age affect the BP in both menopausal and premenopausal participants.


  Conclusion Top


Our study provides evidence that BP among menopausal and premenopausal women is affected by age and BMI. The study also supports the hypothesis that after menopause, risk of higher BP and cardiovascular mortality increases due to reduced endogenous estrogen in the body. A major portion of menopausal women was hypertensive. Hence, probable conclusion can be drawn from our findings that with advancing age in both menopausal and premenopausal women, BMI increases. However, increase is more significant in menopausal women and thus BP also increases. However, to understand the effect of BMI and age on BP in women, further studies are needed to confirm our findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ferrara CM, Lynch NA, Nicklas BJ, Ryan AS, Berman DM. Differences in adipose tissue metabolism between postmenopausal and perimenopausal women. J Clin Endocrinol Metab 2002;87:4166-70.  Back to cited text no. 1
    
2.
Gold EB, Bromberger J, Crawford S, Samuels S, Greendale GA, Harlow SD, et al. Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 2001;153:865-74.  Back to cited text no. 2
    
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Schubert CM, Rogers NL, Remsberg KE, Sun SS, Chumlea WC, Demerath EW, et al. Lipids, lipoproteins, lifestyle, adiposity and fat-free mass during middle age: The fels longitudinal study. Int J Obes (Lond) 2006;30:251-60.  Back to cited text no. 3
    
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Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: Long-term health consequences. Maturitas 2010;65:161-6.  Back to cited text no. 4
    
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Zanchetti A, Facchetti R, Cesana GC, Modena MG, Pirrelli A, Sega R, et al. Menopause-related blood pressure increase and its relationship to age and body mass index: The SIMONA epidemiological study. J Hypertens 2005;23:2269-76.  Back to cited text no. 5
    
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Lim HS, Kim TH, Lee HH, Park YH, Kim JM, Lee BR. Hypertension and age at onset of natural menopause in Korean postmenopausal women: Results from the Korea National Health and nutrition examination survey (2008-2013). Maturitas 2016;90:17-23.  Back to cited text no. 6
    
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Izumi Y, Matsumoto K, Ozawa Y, Kasamaki Y, Shinndo A, Ohta M, et al. Effect of age at menopause on blood pressure in postmenopausal women. Am J Hypertens 2007;20:1045-50.  Back to cited text no. 7
    
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Chen SC, Tsai CL, Chang JH, Hsien WK. Variations in aging gender menopause and Obesity and their effects on hypertension in Taiwan. Int J Hypertens 2014:1-7. [http://dx.doi.org/10.1155/2014].  Back to cited text no. 8
    
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Pérez-López FR, Chedraui P, Gilbert JJ, Pérez-Roncero G. Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: Facing the post-women's health initiative era. Fertil Steril 2009;92:1171-86.  Back to cited text no. 9
    
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Hardy R, Mishra GD, Kuh D. Body mass index trajectories and age at menopause in a British birth cohort. Maturitas 2008;59:304-14.  Back to cited text no. 10
    
11.
Fahey TD, Insel PM, Roth WT. Core concepts and Laboratories in Physical Fitness and Wellness. 3rd ed. Mountain View CA: Mayfield Publishing Company Fit and Well; 2001. p. 20-1.  Back to cited text no. 11
    
12.
Nuttall FQ. Body Mass Index: Obesity, BMI, and health: A critical review. Nutr Today 2015;50:117-28.  Back to cited text no. 12
    
13.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20.  Back to cited text no. 13
    
14.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of sports medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.  Back to cited text no. 14
    
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Amigoni S, Morelli P, Parazzini F, Chatenoud L. Determinants of elevated blood pressure in women around menopause: Results from a cross-sectional study in Italy. Maturitas 2000;34:25-32.  Back to cited text no. 15
    
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Kim HM, Park J, Ryu SY, Kim J. The effect of menopause on the metabolic syndrome among Korean women: The Korean National Health and nutrition examination survey, 2001. Diabetes Care 2007;30:701-6.  Back to cited text no. 16
    
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Chaudhuri A, Borade NG, Tirumalai J, Saldanha D, Ghosh B, Srivastava K. A study of autonomic functions and obesity in postmenopausal women. Ind Psychiatry J 2012;21:39-43.  Back to cited text no. 17
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Zilberman JM, Cerezo GH, Del Sueldo M, Fernandez-Pérez C, Martell-Claros N, Vicario A. Association Between hypertension, menopause, and cognition in women. J Clin Hypertens (Greenwich) 2015;17:970-6.  Back to cited text no. 18
    
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Bade G, Shah S, Nahar P, Vaidya S. Effect of menopause on lipid profile in relation to body mass index. Young Sci 2014;5:20.  Back to cited text no. 19
    
20.
Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight 2019;4:e124865.  Back to cited text no. 20
    
21.
Matthews KA, Kuller LH, Sutton-Tyrrell K, Chang YF. Changes in cardiovascular risk factors during the perimenopause and postmenopause and carotid artery atherosclerosis in healthy women. Stroke 2001;32:1104-11.  Back to cited text no. 21
    
22.
Barrett-Connor E. Menopause, atherosclerosis, and coronary artery disease. Curr Opin Pharmacol 2013;13:186-91.  Back to cited text no. 22
    
23.
Tan MN, Kartal M, Guldal D. The effect of physical activity and body mass index on menopausal symptoms in Turkish women: A cross-sectional study in primary care. BMC Womens Health 2014;14:38.  Back to cited text no. 23
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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