![]() 21 Some research proposes that prescribing 50 mg of metoprolol creates an exposure equivalent to a 100-mg dose in men. Healthy women’s metoprolol drug exposure is higher than men’s, although their elimination half-lives and heart rates are similar. For example, CYP2D6 metabolizes metoprolol. Metabolizing enzymes and sex hormones interact, altering adverse effects (AEs), drug exposure, effectiveness, and elimination. 17-20 Gender-related differences in pharmacodynamics and pharmacokinetics may explain the differences. Limited research suggests that women respond to certain BP medications, such as angiotensin-converting enzyme inhibitors, β-blockers and diuretics, better than men. The American College of Cardiology/American Heart Association 2017 Hypertension Guideline indicates that men and women should start treatment for HTN at the same thresholds.4 Clinical trials have examined many drugs and strategies, with none clearly preferred in women, except possibly thiazide diuretics, which reduce calcium excretion and may prevent osteoporosis. 14 Menopause reduces the estradiol and estrogen/testosterone ratio, which also contributes to endothelial dysfunction. 13 In addition, with age, endothelial function declines pursuant to reduced endogenous estrogen stimulation of nitric oxide synthesis. Polymorphism in men and women differ, with the β-adrenergic receptor and angiotensinogen receptor elevating BP in men and the β-adrenergic receptor and the α2A-adrenergic responsible in women. 12 Geneticists have identified 35 loci with physiological roles in BP regulation. Some research suggests that menopause may trigger expression of certain genetic susceptibilities that modulate BP in women. 10 Increasing age and a slowing metabolism are also associated with weight gain. HTN and menopause have been linked in several studies, and systolic BP seems to be affected more than diastolic, increasing about 5 mm Hg over 5 years. For many women, these goals are challenging, and for middle-aged women who are dealing with menopausal transition, hormonal changes often cause or contribute to HTN. ![]() Targets include consuming adequate folic acid intake, diets favoring fruits and vegetables, limiting alcohol and nonnarcotic analgesics, reaching and maintaining a healthy body mass index, regular physical exercise, and restricting fat and salt. The basic approach to HTN management in women is well documented.
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