Blood pressure and perimenopause: why readings often rise in midlife

For many women, blood pressure enters the picture quietly in their 40s or 50s.

A routine check shows it is higher than expected.A repeat reading confirms it.Medication is mentioned, sometimes sooner than anticipated.

What is often missing from that conversation is why blood pressure changes at this stage of life, and what else may be influencing those numbers alongside age, genetics, and family history.

This is not about avoiding treatment or questioning medical advice.It is about understanding what the body is responding to, so decisions feel steadier and more informed.

During perimenopause, blood pressure often becomes more reactive, meaning it responds more strongly to everyday stress, disrupted sleep, and metabolic strain.

Why blood pressure often shows up during perimenopause

In both Ireland and the UK, raised blood pressure becomes more common with age. Irish research suggests that almost 43% of adults aged 50 and over have high blood pressure, many without obvious symptoms. UK data from the British Heart Foundation shows a similar pattern, with prevalence rising steadily in women after midlife.

For many women, this increase overlaps with perimenopause.

Midlife is often when several pressures converge at once:

• cumulative stress from work and family life

• changes in sleep quality

• shifts in metabolism and hormone patterns

• less tolerance for irregular routines or long gaps between meals

Blood pressure does not rise in isolation. It responds to what the body is carrying.

Blood pressure changes often emerge quietly in midlife. Image source: Canva

Blood pressure reflects load, not just age

Blood pressure is often treated as a stand-alone number. In practice, it behaves more like a signal.

Cardiologists such as Sanjay Gupta increasingly describe blood pressure as a barometer of physiological stress rather than a problem in its own right.

That framing matters. Midlife is when overall load often increases quietly, without one clear trigger. Sleep becomes lighter. Recovery takes longer. Stress hormones stay active for longer periods. The cardiovascular system responds accordingly.

Age plays a role, but it rarely explains the full picture on its own.

The blood sugar and blood pressure connection that is often overlooked

Blood sugar regulation and blood pressure control are closely linked.

They share many of the same systems, including insulin, cortisol, adrenaline, kidney sodium handling, and blood vessel tone. When blood sugar is less stable, whether due to disrupted sleep, long gaps between meals, or ongoing stress, the body compensates.

That compensation relies heavily on stress hormones.

In the short term, this helps keep blood sugar steady. At the same time, it tightens blood vessels, raises heart rate, and makes blood pressure more reactive.

This does not always show up as obvious blood sugar symptoms. Many women simply notice patterns such as feeling wired but tired, increased irritability, afternoon crashes, poorer sleep, or reduced tolerance to caffeine or alcohol.

As insulin sensitivity often declines with age, blood pressure can become more sensitive to everyday stressors, even when weight or salt intake has not changed.

Blood sugar and blood pressure are closely connected. Image source: Ciara Ryan Nutrition

Can perimenopause cause high blood pressure?

Perimenopause does not directly cause high blood pressure, but it does change how the cardiovascular system responds to stress.

Fluctuating oestrogen levels affect blood vessel flexibility, stress hormone responsiveness, sleep quality, and insulin sensitivity. When this happens alongside cumulative stress and broken sleep, the system becomes more reactive.

This helps explain why many women notice:

• borderline or fluctuating readings

• higher readings during appointments

• stronger responses to poor sleep, caffeine, or alcohol

Brief spikes do not automatically mean something is wrong. They often reflect a system working harder to stay balanced.

Reactivity versus fixed high blood pressure

Reactivity describes how strongly the body responds to stressors.

In a reactive system, blood pressure rises more easily and settles more slowly. Reducing overall load often brings stability over time.

Medication can be appropriate and helpful, and it does not need to be the only lens used when blood pressure changes during perimenopause. Understanding what is driving reactivity allows for calmer, more constructive conversations about long term support.

Monitoring over time can reveal patterns, not just numbers. Image source: Canva

What this looks like in practice

Many of the clients I see with high blood pressure are already taking medication by the time they come to me. In other cases, particularly during perimenopause, GPs may suggest looking at diet and lifestyle alongside monitoring, before making further decisions.

I am currently working with a client whose blood pressure had been gradually creeping up. She is not overweight and is in perimenopause. Her GP advised looking at diet and lifestyle first, which gave us space to explore sleep, stress management, blood sugar stability, and overall physiological load. With regular home monitoring in place, her readings have started to settle.

This work usually begins with understanding what the body has been compensating for, rather than assuming the cardiovascular system is failing on its own.

Looking beyond the numbers

Blood pressure changes around perimenopause are rarely just about salt or ageing.

They often reflect blood sugar regulation, stress physiology, nervous system load, and hormonal shifts working together. When those pieces are understood, conversations about blood pressure become steadier and more grounded.

If blood pressure has come onto your radar during perimenopause, looking beyond the number is often the most useful place to begin.

Further reading

The articles below explore related areas that often sit alongside blood pressure changes in midlife.

• Easy-to-follow strategy to improve your heart health - A practical look at everyday habits that support heart health over time, particularly relevant if blood pressure or cardiovascular risk has come onto your radar.

• Taking control of your health: managing and preventing diabetes - Explores blood sugar regulation, insulin resistance, and long-term metabolic health, closely linked to blood pressure changes in midlife.

• The impact of stress on our health - Looks at how ongoing stress affects the body beneath the surface, including sleep, hormones, and cardiovascular strain.

f you’d like to explore these topics in more depth, I share regular notes on nutrition, hormones, stress, and midlife health in my newsletter. You can subscribe here if that feels useful.