High Blood Pressure In Mid
An increase in blood pressure that occurs after the 20th week of pregnancy is called gestational hypertension. Your doctor may diagnose you with hypertension if:
- Your systolic blood pressure is 140 mm Hg or higher
And/or
- Your diastolic blood pressure is 90 mm Hg or higher
If you develop gestational hypertension, your doctor will monitor you closely for signs of preeclampsia.
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High Blood Pressure Before Pregnancy
Women who have high blood pressure before pregnancy may worry about whether they can safely have a baby. Having high blood pressure prior to pregnancy does increase the risk of pregnancy-related health complications. However, the condition shouldnt prevent someone from getting pregnant.
If you plan to become pregnant, work with your primary care provider to get your blood pressure levels under control with medication that is safe to use during pregnancy. Make healthy lifestyle changes ahead of time to help keep your blood pressure in check. Once you become pregnant, your doctor will likely want you to monitor your blood pressure at home and have regular checkups.
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High Blood Pressure After Pregnancy
For most women, preeclampsia and gestational hypertension resolve within 12 weeks of labor or a C-section. Women diagnosed with chronic hypertension may require ongoing monitoring and treatment for high blood pressure.
Sometimes, in addition to blood pressure medication, anti-seizure medications and blood thinners are necessary for women with postpartum preeclampsia. If you have chronic hypertension, your doctor will likely discuss making healthy lifestyle changes to complement the actions of blood pressure medication.If youre nursing, notify your doctor so they can prescribe a medication that is safe for your baby.
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Progesterone And High Blood Pressure
For women who carry this gain-of-function mineralocorticoid receptor mutation, high blood pressure emerges early, before the age of 20 and, for all intents and purposes, is refractory to the normal lifestyle changes and many medications that reduce blood pressure, except perhaps diuretics. The high blood pressure often becomes severe during pregnancy. It may also become severe with any drug that increases progesterone or decreases aldosterone including with oral contraceptives, synthetic progestins , and blood pressure medications that block aldosterone and are derived from 17a- spirolactone. Fourth generation progestin, contraceptives or hormone replacement therapies containing drospirenone are particularly dangerous, as they both bind to progesterone receptors strongly and block mineralocortiocoid activity simultaneously.
It should be noted that boys and men also carry this mutation and are susceptible to early onset hypertension.
Could It Be Your Hormones
Hormones are a lesser-known, but a clear cause of elevated blood pressure. They are tiny chemical messengers that help manage the different processes of the body, like growth, metabolism, breathing, and reproduction.2 An imbalance in these hormones can lead to hypertension. It is very difficult to differentiate hormone-related rise in blood pressure from primary hypertension, where the cause is not identifiable. Doctors usually classify this type of persistent high blood pressure as treatment-resistant hypertension.3
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Sudden Onset During Pregnancy
Some women without any previous history of hypertension can experience the sudden onset of primary aldosteronism during early pregnancy. If this is not identified, monitored and treated, it can lead to complications, the most common of which is pre-eclampsia.
A new study, published in Nature Genetics, has identified two gene variants responsible for this phenomenon.
Both variants are in genes that code for parts of the same molecular switch, known as a G protein. When both variants are present at the same time, the switch can be activated by human gonadotropic hormone a hormone produced during early pregnancy . This then causes the production of high levels of aldosterone and leads to primary aldosteronism.
Both variants must be present for HCG to activate the switch if only one of the variants is present, the switch does not react to the hormone and the person will not develop the condition in this way.
Professor Morris Brown, who supervised the study at Queen Mary University of London and St Barts Hospital, said: What was particularly satisfying is that recognition of the cause of hypertension in these women enabled them to complete a successful pregnancy, and that afterwards they were completely cured of hypertension by a procedure to remove the adrenal nodule, and were able to stop all their drugs.
Discover more about genomics role in pregnancy in our resource for midwives, available here
Elevated Stress Hormones Linked To Higher Risk Of High Blood Pressure And Heart Events
Research Highlights:
- In a study of more than 400 adults with normal blood pressure, those who had high levels of stress hormones detected in their urine were more likely to develop high blood pressure over the next 6-7 years.
- Higher levels of the stress hormone cortisol were also linked to an increased risk of cardiovascular events, including heart attack and stroke.
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DALLAS, Sept. 13, 2021 Adults with normal blood pressure and high levels of stress hormones were more likely to develop high blood pressure and experience cardiovascular events compared to those who had lower stress hormone levels, according to new research published today in Hypertension, an American Heart Association journal.
Studies have shown that cumulative exposure to daily stressors and exposure to traumatic stress can increase cardiovascular disease risk. A growing body of research refers to the mind-heart-body connection, which suggests a persons mind can positively or negatively affect cardiovascular health, cardiovascular risk factors and risk for cardiovascular disease events, as well as cardiovascular prognosis over time.
Participants were followed for three more visits for development of hypertension and cardiovascular events such as chest pain, the need for an artery-opening procedure, or having a heart attack or stroke.
Their analysis of the relationship between stress hormones and development of atherosclerosis found:
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Are There Any Other Hormones You Need To Worry About
In rare cases, there could be a few other hormonal culprits for increased blood pressure, such as cortisol, epinephrine and norepinephrine, the thyroid hormone, and to a certain extent, insulin.4, 6
Epinephrine and norepinephrine, along with cortisol, are secreted by the adrenal gland. They all work together to produce the fight-or-flight response in our everyday life. Its because of these three hormones that we feel the rush of the blood in our veins when we are in a stressful situation. An overworking adrenal gland can secrete these three hormones in varying amounts, which could then become the cause of hypertension.
Studies have also shown a relationship between the changing levels of thyroid hormones and blood pressure fluctuations. Changes in insulin levels are directly linked to diabetes, and diabetes is also a well-known risk factor for hypertension.7, 8
Can Hormones Make Your Blood Pressure Go Up
Changes in hormones during menopause might cause weight gain and make your blood pressure more susceptible to salt in your diet, leading to increased blood pressure. Some kinds of hormone treatment for menopause might cause an increase in blood pressure. For example, estrogen therapy after the loss of the ovaries is known to raise blood pressure due to its effect on vascular function. Androgen deprivation therapy for prostate cancer can also raise blood pressure by similar mechanisms.
Hormone therapy has many benefits for women with menopausal symptoms including alleviating hot flashes and night sweats. However, evidence suggests that using HT increases your risk of developing heart disease and other chronic diseases. So if you’re considering using HT, it’s important to understand the risks vs. benefits for you. Your primary care physician or gynecologist can help you decide what options are right for you.
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High Blood Pressure In Women: Could Progesterone Be To Blame
High blood pressure develops for a number of reasons, with poor diet, lack of exercise and medication key contributors to chronic hypertension. Explaining high blood pressure in young, otherwise active, athletic and healthy individuals is difficult at best, but when the blood pressure seems to wax and wane for no obvious reason, diagnosing and treating this form of hypertension can be downright impossible.
This is where an good percentage of the female population find themselves with treatment refractory high blood pressure, that worsens across the menstrual cycle, during pregnancy and in response to certain formulations of oral contraceptives. Unbeknownst to many of these women and their doctors, they are carriers of a genetic mutation that raises their blood pressure relative to circulating progesterone concentrations. For these women, when progesterone concentrations are high, as during the luteal phase of menstrual cycle, and especially during pregnancy, blood pressure skyrockets uncontrollably. When progesterone concentrations are low and provided lifestyle variables are in check, blood pressure is more manageable.
Effects Of Estradiol On Circulating Factors
Estradiol modulates the synthesis of circulating factors known to influence vascular tone and structure. For example, estradiol increases bradykinin levels and may lower blood pressure by increasing bradykinin synthesis . Estradiol down-regulates the expression of angiotensin converting enzyme in serum as well as in the vasculature and decreases renin release and Ang II formation . These effects are in some respects paradoxical since estradiol stimulates angiotensinogen expression in the liver . Ang II is a potent mitogen for vascular smooth muscle cells and induces vascular remodeling processes associated with hypertension. Therefore, the inhibitory effects of estradiol on the reninangiotensin system may lead to reduced vascular growth. Estradiol also down-regulates the expression of Ang II type 1 receptors in smooth muscle cells . Since these receptors mediate the mitogenic effects of Ang II, estradiol may abrogate the effects of Ang II in part via this mechanism. Our own studies show that estradiol inhibits Ang II-induced growth of human smooth muscle cells in vitro , thus supporting this concept. Additionally, estradiol induces the synthesis of Ang 17, a vasodilator and smooth muscle cell growth inhibitor .
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Birth Control And High Blood Pressure: Which Methods Are Safe For You
- By Huma Farid, MD, Contributor
Three effective forms of birth control contain the hormone estrogen: the birth control patch, combined hormonal birth control pills, and a vaginal ring. Doctors have typically recommended that women avoid birth control with estrogen if they have high blood pressure, which current US guidelines define as 130 mm Hg systolic pressure and 80 mm Hg diastolic pressure, or higher. A recent clinical update in JAMA clarifies whether its safe for some women with high blood pressure to use these forms of birth control.
Why Are Recommendations Around Blood Pressure And Birth Control Being Updated
When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. That happened because the new guidelines tightened standards, as follows:
- normal blood pressure is less than 120 /80 mm Hg
- elevated blood pressure is between 120 and 129 mm Hg and less than 80 mm Hg
- high blood pressure is 130 mm Hg and 80 mm Hg or higher.
With these updated definitions, nearly half of American adults have high blood pressure. Black women are at particularly high risk: more than half of Black women over the age of 19 are diagnosed with high blood pressure.
If a woman has high blood pressure, the JAMA update recommends weighing three factors before starting an estrogen-containing birth control: a womans age, control of blood pressure, and any other risks for heart disease.
The JAMA update reviewed evidence based on an older definition of high blood pressure in the context of birth control use. Further research is needed to better understand how different ranges of blood pressure might affect women using birth control that contains estrogen. However, its unlikely that these recommendations would change further based on the newer definition of high blood pressure.
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Which Birth Control Methods Do Not Contain Estrogen
So, what can women who are unable to use birth control containing estrogen use to prevent pregnancy? The good news is that there are a variety of other birth control methods available, both hormonal and nonhormonal.
- The most reliable forms of birth control without estrogen are the copper intrauterine device , the hormonal IUD, the implant, and sterilization for women or men.
- Nonhormonal methods include the copper IUD, condoms for men or women, cervical cap, and diaphragm.
- Three progestin-only hormonal methods are safe to use: the minipill, the birth control implant, or the hormonal IUD. However, the birth control shot is not recommended for women who have poorly controlled high blood pressure.
If you do have high blood pressure, exercise and dietary changes remain an important component of maintaining your heart health. Discuss with your doctor which birth control options might be best for you, so that you and your doctor can engage in shared decision-making about your preferences.
See the Harvard Health Birth Control Centerfor more information on options.
About the Author
Huma Farid, MD, Contributor
Effects Of Progestins On Vascular Growth
Similar to estradiol, progesterone inhibits mitogen induced growth and proliferation of cardiac fibroblasts , vascular smooth muscle cells and glomerular mesangial cells , which contribute to the vascular and glomerular remodeling associated with hypertension, atherosclerosis and glomerulosclerosis. Little is know regarding the effects of synthetic progestins on vascular growth.
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Can Hormone Imbalance Be The Cause Of Hypertension
Its a cold and rainy afternoon, and you are working calmly at your desk. You start to experience a throbbing headache and profuse sweating. No, your boss hasnt asked you to send in 20 completed project files by the end of the day. Still, your head feels fuzzy. You begin to recollect your entire days schedule, wondering what could be causing it. Then it hits you: its your hypertension pill. You forgot to take the new pill your doctor recently recommended. You rush to take your medicine and wait to feel better.
Hypertension, or high blood pressure, is often described as a silent killer. It refers to the rise in the pressure that blood exerts on the walls of your arteries.1 You never expected to be diagnosed with hypertension. You took care of all the known causes you maintained a healthy lifestyle and healthy body weight, and did not drink or smoke. So, what could be the reason for this diagnosis?
How Is It Treated
Secondary high blood pressure is typically treated by treating the cause of the high blood pressure. Your treatment depends on what is causing your high blood pressure and whether the high blood pressure should be lowered as soon as possible to prevent problems.
If a health problem is the cause, this high blood pressure may return to normal when the other health problem is treated. But treating the condition that has caused your secondary high blood pressure will not always lower blood pressure back to a normal level. In this case, you may need to treat the high blood pressure too.
If a medicine is the cause, this high blood pressure may return to normal if the medicine is stopped or the dose is adjusted.
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How Do The Endocrine System And Kidneys Regulate Blood Pressure
The kidneys act as a hormonal regulator of blood pressure by controlling blood volume. The kidneys’ renin-angiotensin-aldosterone system controls blood volume. Renin is secreted into the blood by juxtaglomerular cells in the kidneys in response to increased blood pressure. Angiotensin II, a hormone that causes constriction of blood vessels, is produced when renin cleaves angiotensin I from the serum protein angiotensinogen. Aldosterone, another hormone produced by the adrenal cortex, acts on sodium reabsorption by epithelial cells in the kidney’s distal tubules and collecting ducts. When blood pressure is high, more renin is released, more angiotensin II is made, and more aldosterone is released by the adrenals all these mechanisms work together to maintain blood volume at a constant level. If blood pressure remains high, the kidneys adapt by increasing their secretion of renin and aldosterone.
The endocrine system regulates blood pressure through two main mechanisms: vasoconstriction and water and salt retention. A decrease in blood pressure increases blood flow to vital organs such as the brain and heart, which increases their resistance to blood flow. This mechanism reduces the workload of these organs and allows them time to recover between heart beats. Vasoconstriction also decreases the amount of space available for blood to flow, which can lead to low blood pressure.
What Are The Mechanisms Of Blood Pressure Regulation
Blood pressure and organ perfusion are controlled by a variety of cardiovascular control systems, such as the baroreceptor reflex and the renin-angiotensin system , and by local vascular mechanisms, such as shear stress-induced release of nitric oxide from the endothelium and the myogenic vascular response.
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What Hormones Regulate Fluid Balance In The Body
The body’s homeostatic regulation systems maintain a balance between fluid gain and fluid loss. Increases in ADH cause the kidney to release more water into the urine, while increased aldosterone activity leads to more salt being reabsorbed by the kidneys, thereby reducing blood volume and pressure.
ADH is released into the blood from the posterior pituitary gland. It regulates the amount of water present in the body by causing the kidney to remove that amount through urine. If the body does not lose enough water, then the ADH level increases, which causes the kidney to retain more water. This cycle is regulated by normal brain functions-if someone is exposed to a hot environment, for example, then their brain senses this temperature change and sends out a signal to increase ADH, which causes them to lose more water via the urine, cooling down internally. Too much ADH can be harmful-it was once used as an anti-diuretic drug before it was discovered that it could cause severe electrolyte abnormalities including hypokalemia . However, today medications are used instead that do not have these side effects.
Aldosterone regulates sodium and water balance within the body.