Women at greater risk of dying of stroke

PHOTO: Women at greater risk of dying of stroke

KUALA LUMPUR - Hypertension may be a leading cause of stroke in both men and women but more women than men die of stroke, said consultant cardiologist Dr Ong Mei Lin.

While most studies have shown that blood pressure (BP) tends to increase with age for both sexes, women before the age of 60 have lower BP than men.

This changes after the age of 60, when over 80 per cent of women have high BP, said Dr Ong.

In Malaysia, 43 per cent of women above 30 have hypertension and after menopause, women are also more than twice as likely to have hypertension.

Besides tending to have more fluctuations in BP, a higher chance of white coat hypertension (elevated BP when seeing a doctor or under stress) and being more sensitive to salt intake than men, older women also tended to be more prone to a rise in the upper (systolic) BP reading than men.

In the elderly, this is the more important cause of heart attacks and stroke than the lower diastolic BP.

Other than age-related hypertension, use of the pill (combined oral contraceptive) and pregnancy can also cause hypertension in some women.

"Besides a family history of hypertension, duration of use of the pill and previous hypertension seen during pregnancy, contraceptive-induced hypertension can also be linked to undetected kidney disease and obesity. However this type of hypertension can be resolved within three months of stopping the pill."

Dr Ong said women, who develop hypertension during pregnancy, should visit a doctor regularly as they were more likely to develop heart disease in later life.

"They should know that the hormone replacement therapy used in women after menopause has little effect or may lower their BP."

She said while the cause of hypertension in both men and women was usually unknown (primary hypertension), in rare cases, hypertension might be secondary to other diseases.

This includes blockages of the arteries supplying the kidneys (renal artery stenosis), abnormal hormone production and certain medication.

In treating hypertensive individuals, she said there was strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons under 60 years of age to a goal of less than 140/90 mm Hg.

"Initial anti-hypertensive treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.

"Other agents can be added if these initial medication, used together, are unable to bring the blood pressure to target levels," said Dr Ong, who is based at Gleneagles Penang.

Besides taking medication to keep blood pressure at healthy levels, she said women could make several lifestyle changes to reduce hypertension.

"Keep a sensible diet, reduce salt and sugar intake, and get at least 30 minutes of regular aerobic exercise most days of the week. Eat more fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts.

"Cut down on fat and red meat, sugars and sugar-containing beverages. Limit alcohol intake to one drink a day and quit smoking to reduce the risk," she said.