Correspondence (letter to the editor): Gynecological Causes Should Not Be Forgotten

With the onset of menopause, the vasodilatory effects of estrogen fail: a causal treatment with a hormone replacement product would often be more effective than an antihypertensive agent that obscures the cause. Incidentally, there are many additional benefits of this therapy, such as improved metabolic status and prevention of joint diseases, osteoporosis, and malignant diseases (such as colon cancer and vulvar cancer). Hypertension can also be caused by a lack of sleep due to working conditions or by slow but steady changes in personal lifestyle. Long-term work in night shifts is also worth mentioning, as this is common in both the health and the care sectors and primarily affects women. Often, these women are also burdened with family and household care. One cannot assume that, because the body can compensate for working night shifts for 10 years, it can also do it for 20 years. Treating this causally would potentially mean a drastic change of lifestyle or job, yet anything is better to unmask this condition than using an antihypertensive, perhaps with a fulminant outcome. If signs of atherosclerosis are already present, an immediate cardiovascular diagnosis is indicated, for example to exclude a relevant carotid stenosis as a cause, before pharmaceutical treatment is started. For hypertension therapy, the physician’s first thought should not be to wonder which antihypertensive drug would be the right one, but rather how to determine the specific causes in this individual patient.