Menopause may not explain women’s midlife pulse pressure rise

Clinical takeaway: Don't wait until menopause to assess vascular risk in women. Rising pulse pressure may begin years earlier, making midlife an important opportunity to identify and monitor cardiovascular risk.

Rising pulse pressure, a marker of aortic stiffness and vascular aging, is associated with cardiovascular disease, dementia, and kidney disease. The accelerated increase in pulse pressure seen in women after midlife has often been attributed to estrogen loss at menopause, but longitudinal evidence supporting that theory has been limited.

In this analysis of 6,760 adults from the Framingham Heart Study, investigators examined pulse pressure and related measures of vascular stiffness over 14 years, including 3,512 women categorized by age at natural menopause and 3,248 men. Pulse pressure followed a U-shaped trajectory across adulthood, declining in younger adults before reaching a nadir and then rising with age.

The key finding was that pulse pressure reached its lowest point and began increasing about a decade earlier in women than in men. Among women, the nadir occurred at ages 37 to 39 years regardless of whether menopause occurred early, at an average age, or late. In contrast, the nadir in men occurred at age 47 years. For postmenopausal women, the pulse-pressure transition preceded menopause by roughly 6 to 19 years.

Other measures of pressure pulsatility showed a similar pattern, while menopause timing had little effect on the age-related trajectories. The findings point to differences in aortic structure and remodeling, rather than menopause timing alone, as a potential explanation for the steeper rise in pulse pressure among women after midlife.

“As a huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife,” senior author Gary F. Mitchell, MD, said.

Source: Habib AY, et al. (2026 Sep 14) Hypertension. Relations of Menopause Timing With Pressure Pulsatility in the Framingham Study