Pregnancy complications tip of the iceberg.

Gestational hypertension during pregnancy is unique to the disease, a serious impact on maternal and child health, maternal and perinatal mortality of the main reasons.

4, menopause and menopause

Menopause is the arrival of the female hormone another sign of change. Peri-menopausal estrogen and progesterone levels began to decrease. The effect of estrogen on angiotensin-converting enzyme (ACE) inhibited the formation. This may be related to increased blood pressure after menopause is most closely connected. One of estrogen's effects on blood pressure have the following aspects: ① vasodilative role. Passing through the endothelial cells, can promote nitric oxide, PGI2 release, inhibit the production of endothelin diastolic blood vessels; via smooth muscle cells, inhibition of Ca into the cell, relax smooth muscle cells. ② renin - angiotensin system, a female hormone angiotensin converting enzyme inhibition and angiotensin receptor expression, lower blood pressure. ③ curb obesity (especially visceral fat accumulation) role. ④ lower body of salt sensitivity. ⑤ regulate autonomic activities.

Clearly estrogen levels decrease after the renin - angiotensin system (RAS) system inhibited weakened, leading to different levels of vasoconstriction and increased activity of the RAS system, the above two areas will lead to high blood pressure. Obesity after menopause can be said to be one of the reasons for increase in blood pressure. Middle-aged men and women after the incidence of obesity are increasing. Obesity can also promote the arrival of menopausal women. Over the past few years after menopause, the body and abdominal fat were significantly increased, and muscle tissue was significantly reduced. Furthermore, application of CT in the abdomen in the analysis, visceral fat with a particular increase its amenorrhea. In addition, women after menopause visceral fat in the abdomen, and insulin resistance (in the relationship between blood pressure and an important indicator) between the positive correlation between an independent. Another serious decrease in the level of E2, increase insulin resistance and promote blood vessels to contract, high blood pressure. The amount of 1 kg each additional risk factors that increase 5% (P <0.001). The amount of increased 4 ~ 6 kg with the risk of hypertension increased 1.25 times the amount of an increase of over 7 kg suffering from hypertension increased 1.65 times. Obesity in postmenopausal women with a number of factors. Leptin (Leptin) is the 1994 American scholar first discovered by the obesity gene (ob) encoding a peptide hormone, human obesity secondary to the central leptin resistance. Sex is the main factor affecting leptin, women were significantly higher than those men, men of the two or three times. Sympathetic effects of leptin, metabolism, cardiovascular system. In the physiology of leptin increased energy metabolism, increased NO production, the impact of NO-dependent / non-dependent vasodilation and sympathetic activity.

Although many areas of estrogen through the impact of blood pressure, but research shows that in most cases, hormone replacement therapy does not reduce postmenopausal women's blood pressure hypertension, which suggested that female hormones after menopause to reduce high blood pressure and can not fully explain the blood pressure in postmenopausal women Increase in the relative, postmenopausal women to reduce androgen degradation, but also play a role. Androgen through the RAS in raising blood pressure, RAS for the occurrence of oxidative stress, to produce vasoconstriction substances, and reduce NO.

In addition, the past two years, some scholars have found that postmenopausal women before and after the changes in blood pressure may be related to hormone changes in women after menopause the female salt-sensitive change. Young did not use oral contraceptives in women, not sensitive to salt, and postmenopausal women, salt sensitivity increased significantly. Renal hemodynamics mediation, with the female hormone significant correlation. At the same time the sodium excretion with the female hormone-related. This mechanism can also explain why older women with diuretics effective.

Smulyan, and other research found that men and women in their lives compared brachial artery in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure were higher than those of women, but with age pulse pressure (PP), the pulse conduction velocity ( PWV), and so there will be some differences and changes. Before the age of 40, PP men than women, after 55 years of age, women than men. Apart from the above-mentioned changes in the endocrine reasons for the participation, but also with the female body and the arteries of the tree, these factors hemodynamics. Such as fast heart rate, stroke volume small, so that women SBP, DBP were lower than men. From the left ventricle to pump blood, blood formation of the volatility to a certain speed along the arterial blood vessels to spread around, there are vascular bifurcation of the relatively narrow the artery or arteries when the wave to return to the heart, this time at the end-systolic left ventricular heart Or diastolic early. Women than men short in length, its relatively short arterial tree, the artery to return to the wave faster and landed the former-the systolic pressure wave, the expansion of the peak systolic blood pressure, diastolic not fall into the diastolic blood pressure less than male relative, Therefore, the elderly female patients with hypertension of the PP is higher than that of men, women and elderly patients with hypertension more performance for systolic hypertension. Because the evidence-based medicine and epidemiology are confirmed, PP increase can add to the process of atherosclerosis, the increase in cardiovascular events, from another angle, may be several years after menopause women significantly increased cardiovascular events yet another mechanism.

5, treatment of hypertension in women

So far antihypertensive treatment on a large-scale tests are to male patients as the main body. On the whole no matter male or female patients with hypertension, can benefit from antihypertensive treatment, some study has confirmed the antihypertensive treatment of women in the prevention of stroke in patients with hypertension benefit from higher than in men, and in the prevention of coronary heart disease in men than women. Comparing different antihypertensive drugs in the relief and prevention of cardiovascular events in the different aspects of small, the study has confirmed the potential for certain types of antihypertensive drugs, gender among patients with gender differences do exist. Because male and female high blood pressure, the onset of mechanisms do have differences in the future, this area also needs further confirmed that evidence-based medicine.

5.1 non-drug therapy

Lifestyle changes for the benefit of female patients with hypertension inferior to men. Quality control of female patients than male patients difficulties, but by the antihypertensive effect of salt was higher than that of men.

5.2 drug therapy

At present between the sexes reported by the antihypertensive effect of antihypertensive drugs may be differences between different types of antihypertensive drugs caused. For example, β-stop agent, for use on the same dose of the drug, women decreased heart rate and blood pressure better. Β-stop is the same agent, also have the opposite result. ACEI women may be in effect as hypertension calcium channel to prevent agents and diuretics, the reason may be because compared with male patients, RAS activity Shaoruo. Diuretics may be more effective for women patients, but the older patients, easy-cycle appears insufficient. Some adverse reactions such as diuretics caused by the plasma disorder, ACEI caused by the dry cough and other more in women. In drug treatment less effective, attention should be paid to whether the use of oral contraceptives. - Dopa (Methyldopa), benzene hydrazine of triazine (Hydralazine), and other drugs in pregnancy-induced hypertension patients with more security, calcium channel blocker could also be used for pregnancy-induced hypertension, but some people feel that the best late in pregnancy do not use, Impact of childbirth.

5.3 pregnancy should not use the pressure-relief drugs

① ACE-I: may cause fetal growth retardation, amniotic fluid is too small, or neonatal renal failure, may cause fetal malformation.

② Ⅱ angiotensin-receptor antagonist (AT1 receptor antagonist): adverse reactions Ibid.

③ diuretics: the controversial drug. Can be combined with other drugs to increase efficacy. But some people feel that diuretics could further reduce blood volume to increase fetal hypoxia. Of hypovolemia preeclampsia women, unless there oliguria, otherwise inappropriate use of diuretics.

In short, women have unique high blood pressure, high blood pressure-related problems of women, in particular the clinical treatment of the evidence is still not sufficient. Women should be as high blood pressure diagnosis and treatment of hypertension in the treatment of a group of special populations