POST MENOPAUSAL HYPERTENSION – PATHOPHYSIOLOGY, MOLECULAR MECHANISM, THERAPEUTIC STRATEGIES AND NEWER APPROACHES

Dr. Virendra Kushwaha*, Dr. Pooja Agrawal, Dr. B. K. Shoraisham, Dr. Mohd. Aamir, Dr. Shivangi Raj Singh, Dr. Mayuri Krishnan

ABSTRACT

Menopause is a complex biological transition characterized by permanent cessation of ovarian function and progressive estrogen deficiency, resulting in profound cardiovascular, metabolic, neuroendocrine, and vascular alterations. Among these consequences, postmenopausal hypertension has emerged as a major cardiovascular disorder and an important contributor to morbidity and mortality in aging women. The pathophysiology is multifactorial and involves endothelial dysfunction, arterial stiffness, oxidative stress, chronic low-grade inflammation, activation of the renin–angiotensin–aldosterone system, sympathetic nervous system overactivity, mitochondrial dysfunction, metabolic syndrome, and vascular remodeling. These interconnected mechanisms accelerate vascular aging and increase susceptibility to coronary artery disease, stroke, heart failure with preserved ejection fraction, chronic kidney disease, and cognitive decline. Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause; however, its cardiovascular effects are influenced by age at initiation, timing relative to menopause onset, route of administration, hormonal formulation, and baseline cardiovascular risk profile. Contemporary evidence supports individualized and risk-stratified use of MHT, particularly in symptomatic women younger than 60 years or within 10 years of menopause onset. Recent advances in menopause neurobiology have identified hypothalamic neurokinin pathways as central mediators of vasomotor symptoms, leading to the development of novel non-hormonal therapies such as neurokinin receptor antagonists. In addition, phytoestrogens, microbiome-based approaches, pharmacogenomics, artificial intelligence-assisted risk prediction, and precision medicine strategies are emerging as promising future directions in menopause management.

Keywords: Menopause, Postmenopausal hypertension, Menopausal hormone therapy, Endothelial dysfunction, Estrogen deficiency, Neurokinin receptor antagonists.