Diastolic Heart Failure and Hypertension in Women

Heart disease remains the leading cause of death for women. Over 60 million women in the United States are living with some form of heart disease. And in 2018, one in five American women died of heart disease. Hypertension (high blood pressure) and diastolic heart failure (HF) are among the top heart health concerns with specific risk factors for women. 

This feature will explore risk factors for hypertension and HF and offer recommendations for self-management and treatment options that all women should be aware of. 

Women-Specific Risk Factors for Hypertension / Diastolic HF

Understanding the specific risks that women face is crucial for the prevention, early detection and effective management of hypertension and diastolic heart failure.

• Hormonal changes. Fluctuations of hormones during the menstrual cycle, pregnancy and menopause can impact blood pressure and heart function.
• Menopause. Post-menopause, women often experience a rise in blood pressure due to the decrease in estrogen levels, which can adversely affect the heart and blood vessels.
• Pregnancy-related conditions. Conditions like preeclampsia and gestational hypertension increase the risk of developing chronic hypertension and heart issues later in life.
• Autoimmune diseases. Women are more prone to autoimmune diseases, which can affect the heart and blood vessels, leading to increased risk.
• Stress and mental health. Women may experience unique stressors and mental health challenges that can contribute to hypertension. Chronic stress and conditions like anxiety and depression have been linked to an increased risk of high blood pressure and heart disease.
• Socioeconomic factors. Factors such as access to health care, health literacy, and lifestyle choices influenced by socioeconomic status can also play a role in the risk and management of hypertension and heart failure in women.
• Physical differences between men and women. A woman’s heart and blood vessels are smaller than a man’s, and the muscular walls of women’s hearts are thinner.

Defining Hypertension and Diastolic Heart Failure

Hypertension and diastolic heart failure are two interconnected cardiovascular conditions, each with its own diagnostic criteria and implications.

Hypertension (High Blood Pressure)
Hypertension is defined as having consistently high blood pressure. The American Heart Association (AHA) categorizes blood pressure as hypertensive if the systolic pressure (the top number) is 130 mm Hg or higher or the diastolic pressure (the bottom number) is 80 mm Hg or higher. 

Women are just as likely to develop high blood pressure as men and women represent almost 52% of deaths from high blood pressure, according to the AHA.

Diastolic Heart Failure (HF)
Diastolic heart failure occurs when the heart’s lower chambers (the ventricles) can’t relax properly between beats. This means the heart doesn’t fill with blood efficiently, resulting in a lack of oxygen-rich blood pumped to the body.

The link between hypertension and heart failure, particularly diastolic heart failure, is well-established. For women, the HF incidence rate triples between ages 65 to 74 and 75 to 84 years, as opposed to doubling for men in the same time frame. Women tend to develop HF at an older age compared to men.

Heart Failure Prevention After a Hypertension Diagnosis

Thanks to concentrated campaigns like Go Red for Women, many are aware that heart attack symptoms can look different in women than men. The same is true for specific heart conditions, like HF. Symptoms can include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, tiredness and lack of energy. These are nonspecific, so they may contribute to the fact that women are less likely to be referred for specialty care or diagnostic testing.

Effective management of hypertension in women is crucial for preventing the progression to heart failure. Maintaining blood pressure within a normal range is the most critical aspect of preventing heart failure. This often requires a combination of lifestyle changes and medication.

Lifestyle Modifications
Certain lifestyle modifications can help prevent the progression to heart failure. These include.

• Diet. Adopt a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and whole grains and low in saturated fat. People should monitor their sodium intake, as although lowering sodium can lower blood pressure in as many as 75% of cases, according to one study, other studies stress the need to maintain a balance. Too little sodium can also have a detrimental impact on people’s heart health.
• Exercise. Regular physical activity helps in maintaining a healthy weight and improves heart health.
• Weight management. Losing weight, if overweight or obese, can significantly reduce the strain on the heart.
• Limiting alcohol and quitting smoking. Both are essential in reducing heart disease risk. 
• Managing diabetes. Women with diabetes have a higher risk of developing coronary heart disease than men with the same condition. While everyone should manage their diabetes, it’s particularly important for women’s heart health.

Consistent use of prescribed medications like ACE inhibitors, beta-blockers, diuretics or calcium channel blockers is crucial in managing hypertension in women. Additionally, frequent monitoring of blood pressure and heart health helps in the timely adjustment of treatment strategies.

Lifestyle Changes for Prevention and Management

Lifestyle changes play a pivotal role in the prevention of both hypertension and diastolic heart failure and their ongoing management. These changes are often considered the first line of defense and can significantly influence the course and severity of these conditions.

Prevention
To prevent or delay the onset of hypertension and HF, consider the following: 

• Heart-healthy eating. Following diets like the DASH (Dietary Approaches to Stop Hypertension) or Mediterranean diet, which emphasize fruits, vegetables, whole grains, lean protein and healthy fats.
• Reduce sodium intake. High sodium intake is a known risk factor for hypertension. However, too little sodium can also contribute to mortality.
• Regular physical activity. Regular exercise, such as brisk walking, swimming or cycling, helps maintain a healthy weight and improves overall cardiovascular health. The CDC recommends people engage in at least 150 minutes of moderate-intensity aerobic activity per week.
• Weight management. Maintaining a healthy weight is crucial, as obesity is a significant risk factor for both hypertension and heart failure.
• Limiting alcohol and avoiding tobacco. Excessive alcohol consumption and smoking are both risk factors for heart disease and hypertension. Smoking raises a woman’s risk of heart disease more than it increases the risk for men.
• Stress management. Chronic stress can contribute to high blood pressure and heart disease. Techniques like meditation, yoga or counseling can be effective.

Management
Once you have a hypertension or HF (particularly diastolic heart failure) diagnosis, lifestyle changes become an integral part of the management plan. In addition to those listed above, consider:

• Diet and nutrition. Adhering to a low-sodium diet is even more critical when managing heart conditions. Monitoring fluid intake might be necessary in heart failure to prevent fluid overload.
• Exercise. For those with heart failure, exercise routines may need to be adjusted. Cardiac rehabilitation programs can offer tailored exercise plans that are safe and effective.
• Sleep hygiene. Good sleep is vital for heart health. Disorders like sleep apnea can exacerbate heart problems, so be sure to check in with your doctor about any sleep issues.

Self-Management Techniques for Managing Hypertension and Diastolic Heart Failure

Self-management is a critical aspect of living with and managing conditions like hypertension and diastolic heart failure. It empowers people to take an active role in their care, leading to better health outcomes. 

Digital Tools
Many digital tools are available for people to manage their own health.

• Blood pressure monitors. Home blood pressure monitors are crucial for women with hypertension. Regular monitoring helps in keeping track of trends and understanding triggers.
• Heart rate and activity trackers. Devices like fitness bands and smartwatches can track heart rate, physical activity and even sleep patterns, which are important in managing heart health.
• Mobile health apps. Apps like Cormeum are designed to help manage hypertension and heart failure, offering features like medication reminders, blood pressure logging, dietary tracking and educational content.

Support and Community
Both online and in-person support groups can provide emotional support and practical advice from others dealing with similar health issues.

• Social media. Platforms like Facebook and Reddit have communities where members share experiences, advice and support.
• Counseling and therapy. Professional counseling or therapy can be beneficial, especially for dealing with the stress and emotional aspects of chronic illness.

Lifestyle Management Tools

• Dietary guides and meal planners. Seek out tools that help plan heart-healthy meals, taking into consideration specific nutritional needs and preferences.
• Exercise programs. Tailored exercise programs, especially cardiac rehabilitation programs for heart failure patients, can be very beneficial.
• Stress reduction techniques. Resources for yoga, meditation and other stress-reduction methods can be found through local community centers, apps or online platforms. Be sure to check in with your care team before beginning a new exercise program. 
• Sleep tracking. Devices and apps that help monitor sleep quality, which is an important aspect of heart health.

Next Steps for Hypertension Management

Effective self-management of hypertension and HF involves a combination of education, the use of digital tools, lifestyle modifications and community support. These resources empower women to take control of their health, leading to improved outcomes and quality of life. It’s important for women to find the tools and resources that work best for their needs and lifestyle.