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  3. 24.Perimenopausal Females Continue to Have High Blood Pressure Spikes Inspite of Taking Regular Antihypertensive Use – Need to Manage the Symptoms Not the Cause
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24.Perimenopausal Females Continue to Have High Blood Pressure Spikes Inspite of Taking Regular Antihypertensive Use – Need to Manage the Symptoms Not the Cause

Muhammad Mohsin Rana1, Danish Gani2, Nauman Khalid3, Adnan Afzal1, Qasim Rauf4 and Muhammad Wasim Afzal1

ABSTRACT

Objective: To recognize the inability of antihypertensive medicine to control BP spikes during VMS 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 July 2022 to February 2023.

Materials and Methods: Females presenting to OPD for the control of HTN between 30-70 years of age using regular antihypertensive medicine and experiencing the Vasomotor Symptoms (VMS). STRAW staging system was used to define the menopause. After securing informed consent, applying inclusion and exclusion criteria Composite Symptoms Severity Score was assessed on the prescribed modified MENQOL questionnaire proforma. Average of all the available recorded readings (10 at least) of BP in the period since antihypertensive medicines are being used regularly was documented. In the absence of written record we recorded the values given by recall.  Office reading of BP was taken within half hour of the VMS symptoms as per JNC7 guidelines at the time of the visit. antihypertensive medicines (by the group) being used by the patient were noted as per standard.

Results: We had 346 patients during the study period. We had 4% in 4th decade, 36% in 5th decade, 47% in 6th decade and 13% in 7th decade of life, this is expected and in accordance with the literature. We divided the patients in 3 groups, low score <50 composite severity score index (CSSI), intermediate score 50-100 CSSI, severe score >100 CSSI for the sake of convenience of interpretation. Most of the patients in 4th and 7th decade had low CSSI, 79% and 13%.  Most of the patients in 5th and 6th decade had intermediate CSSI, 47% and 52%. High score was seen in relatively fewer patients in all 4 decades, 10%, 19%, 19% and 7%.Average home BP record mostly fell into hypertensive range (higher than 140/100 mmHg), matching the CSSI score in all three groups with wide fluctuation well reflected in SD while still regularly using antihypertensive medicine. Office BP measured after at least half hour of the hot flushes was still high in all age groups and all CSSI score groups.

Conclusion: These findings reinforce our hypothesis that antihypertensive medicines fails to control spikes of high BP during VMS symptoms in spite of good compliance. It must be appreciated that BP spikes are mediated through a different mechanism other than the classical aldosterone-renin-angiotensin mechanism of essential hypertension. A different approach is needed, if we control the VMS, BP swings will be minimized without antihypertensive medicine thereby avoiding unnecessary and wrong prescription.

Key Words: Peri-menopausal syndromes, vasomotor perimenopausal symptoms, hot flushes, hypertension.

Citation of article: Rana MM, Gani D, Khalid N,  Afzal A, Rauf Q, Afzal MW. Perimenopausal Females Continue to Have High Blood Pressure Spikes Inspite of Taking Regular Antihypertensive Use – Need to Manage the Symptoms Not the Cause. Med Forum 2023;34(6):102-106.