Study Finds Aortic Structure May Influence Midlife Increases in Pulse Pressure Among Women

Heart health changes related to ageing may begin much earlier in women than previously thought, with new research suggesting pulse pressure may start shifting nearly two decades before menopause.

Published in Hypertension, the study analysed 6,760 women from the Framingham Heart Study. Researchers examined pulse pressure, the gap between the upper and lower blood pressure numbers. A wider pulse pressure can signal a stiffer aorta.

The researchers found that pulse pressure reached its lowest point and then began rising in women in their late 30s, around a decade earlier than in men. The timing was not affected by whether women experienced early, average or late menopause.

This change occurred up to 20 years before the final menstrual period. After midlife, pulse pressure rose faster in women. By age 60, women had a higher average pulse pressure than men.

The findings challenge the idea that menopause itself is the main trigger for increasing aortic stiffness. Researchers suggest that vascular ageing may begin years before menopause, although changes could accelerate during the menopause transition.

A wide pulse pressure is associated with higher risks of cardiovascular disease, dementia and kidney disease. It may also indicate blood vessel ageing and make high blood pressure harder to treat with usual medicines.

Researchers said doctors should pay closer attention to pulse pressure in women. A pulse pressure above 60 mm Hg, such as 130/70 mm Hg, may warrant monitoring over time.

However, the observational study cannot prove cause and effect, and menopause timing was self-reported. Most participants were of white European ancestry, so the findings may not apply equally to all populations.

Experts say cardiovascular health should be addressed well before menopause, giving women an opportunity to identify and manage risk early and better protect long-term heart health.

REFERENCE: Amy Y. Habib, et al.; Relations of Menopause Timing With Pressure Pulsatility in the Framingham Study; Hypertension; 2026; DOI: 10.1161/HYPERTENSIONAHA.126.27015