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Mohammad Mohsin Rana¹, Muhammad Saleem Akhtar¹, Muhammad Ikram ul Haq¹, Danish Gani², Nauman Khalid³ and Asma Malik¹

ABSTRACT

Objective: Hypertension is among the leading cause for cardiovascular and cerebrovascular morbidity and mortality, essential hypertension being the commonest reason. Vasomotor symptoms during perimenopausal period are well known to adult females. Hot flushes, palpitation and cold sweating phase is accompanied by a temporary swing in BP leading to erroneous labelling as Hypertension. This aims at separating essential Hypertension from temporary rise in BP as part of vasomotor symptoms in perimenopausal females.

Study Design: Observational Cross sectional study

Place and Duration of Study: This study was conducted at the Rai Medical College Teaching Hospital, Sargodha from January to October, 2022.

Materials and Methods: After securing for presence of perimenopausal symptoms informed consent was taken.  BP was recorded as per standard protocol, if possible during and after the symptoms at the office as per JNC7 protocol with cutoff value of 140/90 mm Hg. Patients continued the routine antihypertensive medication if any. These patients were asked to record their BP at home multiple times, half of the times while experiencing the symptoms or within a short time afterwards and half of the time at least one hour after the perimenopausal symptoms of hot flash, palpitation and sweating. This record was reviewed at 2 weeks. If BP remained normal in between the symptoms, antihypertensive medicines were stopped. They were asked to continue recording BP for another 2 weeks on same pattern. Patients were instructed to report early if BP is high one hours after the vasomotor symptoms. 

Results: We had 378 eligible and volunteering females enrolled in this study during the study period. All claimed to be hypertensive, 42% (n 158) were taking antihypertensive medicines regularly and rest 58% (n219)were taking irregularly mostly as on demand during the VSM symptoms. The study population was divided in < 40, 40-49, 50-59 and >60 years age groups. There is a clear-cut evidence that there was a significant drop in BP when the females are not experiencing the VSM symptoms, a drop of 70 mmHg in systolic BP and a drop of 10 mmHg in diastolic BP was observed at initial assessment when VSM symptoms has waned off. At first follow-up, 228 out of 378, 60% remained normotensive when not experiencing VSM symptoms. The patients who were still hypertensive were advised to continue their antihypertensive medicine.10% in 40-49 years and 7% in 50-59 years age group stayed normotensive even after stopping the antihypertensive medicines. 18% stayed normotensive even after discontinuing their medicine patients in >60 years age group.

Conclusion: It becomes very apparent that BP returned to normal in 100% of women in <40 years group, 73% of women in 40-49 years group, 51% of women in <50-59 years group and 18% of women in >60 years group when they were not experiencing the VSM symptoms on the basis of home monitoring for 2 weeks. 60% remained normotensive when not experiencing VSM symptoms, these were inadvertently labelled as hypertensive when this VSM phenomenon was not considered. In these 60% of patients reassurance and explanation of the phenomenon of VSM symptoms complex and temporary rise in BP being part of it helped to calm them. These were inadvertently labelled as hypertension as VSM phenomenon was not considered in these patients. We conclude that up-shoots in BP during the perimenopausal years must be considered as part of VSM phenomenon and shall not be labelled as hypertension

Key Words: Vasomotor symptoms, Hypertension, Perimenopausal Symptoms

Citation of article: Rana MM, Akhtar MS, Ikram ul Haq M, Gani D, Khalid N, Malik A. Inadvertent Labeling of Perimenopausal Females as Hypertension during Vasomotor Symptoms, Experience at a Tertiary Care Hospital Med Forum 2023;34(3):58-62.