Managing hypertension in women's health

Hypertension is a common, yet under-recognised condition affecting around one in three women in Australia, with prevalence rising steeply with age. Although rates increase in both sexes over the life course, there is a marked rise in women after menopause. Over the age of 65, the prevalence of hypertension in women exceeds that of men. Prevalence peaks in women over the age of 85, with almost half of women aged 85+ living with hypertension, making early diagnosis and management essential.

Diagnosing hypertension

Hypertension is often identified opportunistically — for example, during routine consultations, contraception reviews, antenatal care and menopause management. In fact, most consultations with female patients offer an opportunity to check blood pressure in the clinic.

Hypertension is typically diagnosed when clinic blood pressure is persistently ≥140/90 mmHg. However, a single elevated clinic reading should be interpreted with caution, and repeat or out-of-office measurements are recommended to confirm the diagnosis.

Risk factors

Female-specific risk factors play an important role in both the development and progression of hypertension. Hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia, are recognised as significant predictors of future cardiovascular disease, so women with a history of these disorders should be prioritised for blood pressure screening. Younger women with conditions associated with hormonal and metabolic dysfunction, such as premature ovarian insufficiency, polycystic ovary syndrome and infertility, also appear to be at increased risk of developing hypertension.

Management

Once a diagnosis of hypertension is established, management should be individualised and holistic. An overall cardiovascular risk assessment should be conducted, including screening for other conditions such as diabetes, obesity and hypercholesterolaemia. Tools such as the Australian CVD risk calculator are available to aid in estimating cardiovascular risk.

Lifestyle modifications remain foundational to managing hypertension and cardiovascular risk and are particularly important for women. Weight reduction, dietary sodium restriction, regular aerobic exercise, and moderation of alcohol intake can result in clinically meaningful reductions in blood pressure, alongside broader cardiometabolic benefits. Smoking cessation should be strongly encouraged to reduce overall cardiovascular risk.

Although lifestyle interventions can lower BP and reduce total cardiovascular risk, many patients with hypertension require pharmacological treatment in addition to behavioural strategies. The decision to start antihypertensive medication should be based on the severity of hypertension and overall cardiovascular risk factors. First-line pharmacological options include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide or thiazide-like diuretics, selected according to individual patient factors. In women of childbearing potential, effective contraception should be discussed before initiating potentially teratogenic medications, and pregnancy-safe alternatives should be used where appropriate. During pregnancy, management of hypertension differs significantly, with medications such as labetalol, nifedipine, or methyldopa preferred, and close obstetric collaboration is required.

Adverse effects from antihypertensive drugs are reported more frequently in women than in men, and women may be more likely to discontinue therapy due to side effects. Regular review, monitoring and shared decision-making are therefore essential to optimise adherence and long-term outcomes.

In summary, hypertension remains a common and clinically significant issue in women’s health. Primary care clinicians are ideally placed to identify at-risk women, initiate early intervention, and address female-specific considerations, including pregnancy and menopause. A proactive, evidence-based approach to blood pressure management can substantially reduce long-term cardiovascular risk and improve health outcomes for women.

- Dr Samantha Miller, MBChB

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References

1. National Institute for Clinical Excellence (NICE)(2025). Clinical Knowledge Summary: Hypertension. https://cks.nice.org.uk/topics/hypertension/
2. BMJ Best Practice (2025). Essential Hypertension. https://bestpractice.bmj.com/topics/en-gb/26
3. The Royal Australian College of General Practitioners (2012). Management of hypertension in general practice A qualitative needs assessment of Australian GPs. https://www.racgp.org.au/afp/2012/may/management-of-hypertension-in-general-practice
4. Department of Health, State Government of Victoria, Australia. Better Health Channel: Blood pressure (high) – hypertension. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/blood-pressure-high-hypertension
5. Australian Institute of Health and Welfare (AIHW) (2019). High blood pressure. https://www.aihw.gov.au/reports/risk-factors/high-blood-pressure/contents/about
6. Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. https://doi.org/10.1161/HYP.0000000000000066
7. Heart Foundation (2016). Guideline for the diagnosis and management of hypertension in adults. https://assets.contentstack.io/v3/assets/blt8a393bb3b76c0ede/bltbf3d36e10b48f01f/65b0963ea933e532ae0286de/01_Hypertension-guideline-2016_WEB.pdf
8. Australian CVD Risk Calculator. https://www.cvdcheck.org.au/calculator
9. Brown, M. C. et al (2013). Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. European journal of epidemiology, 28(1), 1–19. https://doi.org/10.1007/s10654-013-9762-6