A new study published in Hypertension, a peer-reviewed journal of the American Heart Association, suggests that the midlife rise in pulse pressure and aortic stiffness in women may not be primarily driven by menopause, as previously thought. The research, based on data from the long-running Framingham Heart Study, found that pulse pressure begins to increase about two decades before women reach menopause, indicating that vascular aging starts much earlier than the final menstrual period.
The aorta, the body’s largest blood vessel, delivers oxygen-rich blood from the heart to other organs. Over time, its walls can stiffen, leading to a wider pulse pressure—the difference between systolic and diastolic blood pressure readings. A wider pulse pressure means the heart works harder and can damage small vessels in organs like the brain and kidneys. It is a major risk factor for cardiovascular disease, dementia, and kidney disease, and may make high blood pressure less responsive to standard medications.
The study analyzed data from 6,760 women and 3,248 men in the Framingham Heart Study, following them over 14 years. Researchers found that pulse pressure reached its lowest point and began to rise around age 38 in women, compared to age 48 in men. The timing of menopause—whether early, average, or late—had no influence on when this transition occurred. After midlife, pulse pressure increased faster in women, resulting in higher average pulse pressure in women than men after age 60.
“Many people believe that the change in pulse pressure is linked to the hormonal shifts caused by menopause. Here, we are evaluating whether the timing of this change, from falling to rising pulse pressure, is connected to menopause timing in a long-term study,” said study senior author Gary F. Mitchell, M.D., a longstanding NIH-funded investigator with the Framingham Heart Study and president of Cardiovascular Engineering, Inc.
The findings suggest that factors other than menopause are at play. “To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife,” Mitchell said. He emphasized that healthcare professionals should consider pulse pressure in middle-aged and older patients, especially women with high blood pressure. “Because women’s overall heart disease risk is lower, they are often told that a blood pressure that is ‘borderline’ can just be watched. However, women and their doctors should sound the alarm if pulse pressure is higher than 60 mm Hg and track it over time.”
Samar R. El Khoudary, Ph.D., M.P.H., FAHA, who chaired the writing group for a 2020 American Heart Association scientific statement on the menopause transition, noted that vascular aging may begin years before menopause. “We shouldn’t wait until menopause to start thinking about cardiovascular health. By the time a woman reaches her final menstrual period, vascular changes may already have been underway for years,” said El Khoudary, who was not involved in the study. She added that midlife is an opportunity to identify cardiovascular risk early and intervene before disease develops.
The study’s limitations include its observational design, reliance on self-reported menopause age, and a predominantly white European descent participant group, which may limit generalizability. The research underscores the importance of monitoring pulse pressure as a marker of vascular health and tailoring treatment approaches for individuals with wide pulse pressure.
For more information on menopause and heart health, visit the American Heart Association’s health information page. The manuscript will be available online after September 14, 2026, at Hypertension.
