05 Feb 2026: To coincide with the Go Red for Women campaign from the American Heart Association, marked on 6 February, Azra Mahmud, Chair of the ISH South and Central Asia Regional Advisory Group, reflects on the importance of redesigning hypertension care for women.

The Go Red for Women campaign reminds us that cardiovascular disease is the leading cause of death in women. But when it comes to hypertension – the most important risk factor behind that statistic – women are still too often unheard. Hypertension is frequently described as a “silent” condition. Many women would disagree.

In clinics, women with high blood pressure talk about headaches, palpitations, fatigue, dizziness, poor sleep, and a sense that something is wrong. They also talk about medication side effects – light-headedness, cramps, cough, electrolyte disturbances – and the frustration of being told to “just keep taking the tablets.” Too often, these experiences are dismissed as anxiety or poor adherence, rather than recognised as real and predictable challenges.

This expectation – that women’s hypertension must resemble male patterns before it is taken seriously – echoes what has long been described in cardiovascular medicine as the Yentl syndrome.

What we sometimes forget is that hypertension behaves differently in women.

With ageing, women are more likely to develop higher systolic blood pressure, increased arterial stiffness, and a greater pulsatile pressure load on the heart and brain. These patterns help explain why hypertension in women more commonly leads to hypertensive heart disease, heart failure with preserved ejection fraction, atrial fibrillation, stroke, non-obstructive coronary artery disease, and vascular cognitive impairment, rather than classic obstructive coronary disease.

Hypertension in women is also shaped by a higher burden of metabolic risk, physical inactivity, and chronic stress. In many settings – particularly in South and Central Asia – women face constrained opportunities for physical activity, higher rates of central obesity and metabolic syndrome, and sustained psychosocial stress linked to caregiving, financial insecurity, and limited autonomy. These are not lifestyle “choices” but powerful determinants of blood pressure across the life course.

But perhaps the most neglected chapter in women’s hypertension is pregnancy.

Hypertensive disorders of pregnancy – including pre-eclampsia and eclampsia – remain a major cause of maternal and perinatal illness and death worldwide. In South and Central Asia, gaps in antenatal surveillance, delayed recognition, and inconsistent access to timely treatment contribute to unacceptably high maternal and foetal mortality. Pregnancy-related hypertension should not be viewed as a problem that ends with delivery; it is an early warning sign for future chronic hypertension and cardiovascular disease.

Go Red for Women has succeeded in raising awareness. The next step is redesigning care – recognising that hypertension in women has a different physiology, different risks, and different social context.

Listening to women’s experiences, taking pregnancy seriously, and tailoring hypertension care accordingly is not about special treatment. It is about better treatment – and better outcomes – for women everywhere.

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