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Influence of menopause on cardiovascular responses to behavioral stressors: A comparative study

Ashwini N Patil, Sunita M Handergulle.

Background: There is increased cardiovascular morbidity and mortality in post-menopausal women as compared to pre‑menopausal women. There is an altered autonomic control with a shift toward sympathetic hyperactivity in menopause. Abnormal autonomic activity, behavioral stressors, and estrogen deficiency are related with increased cardiovascular risk. However, the underlying cardiovascular mechanisms in menopause still remain unclear.

Aims and Objectives: The aim of this study is to determine and compare the following parameters indicating cardiovascular sympathetic function status in pre-menopausal and post-menopausal women subjected to three behavioral stress tests: (i) Blood pressure (BP) response to sustained isometric handgrip test, (ii) BP response to cold pressor test, and (iii) BP response to standing from supine position (orthostasis).

Materials and Methods: This was a cross-sectional study for which 150 pre-menopausal and 150 post-menopausal women were selected. They underwent three behavioral stress tests of sustained isometric handgrip test, cold pressor test, and orthostatic test. The parameters indicating cardiovascular sympathetic function status were determined. Statistical analysis was performed using Z-test.

Results: Diastolic BP (DBP) response to sustained isometric handgrip and systolic BP (SBP) and DBP response to the cold pressor test showed statistically highly significant (P < 0.001) greater rise in post-menopausal women as compared to pre-menopausal women. SBP response to standing from the supine position showed statistically insignificant (P > 0.05) greater fall in post-menopausal women.

Conclusion: Sympathetic hyperactivity in response to behavioral stressors seen in post-menopausal women as compared to pre-menopausal women, suggests that the cardiovascular changes related to estrogen deficiency occurring in menopause may trigger adverse cardiovascular events.

Key words: Menopause; Behavioral Stress; Cardiovascular Response; Estrogen

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