Ambulatory Blood Pressure Profile in Premenopausal and Postmenopausal Women With Metabolic Syndrome

Menopause is a critical transition in a woman’s life, marked by profound hormonal, metabolic, and cardiovascular changes that influence blood pressure (BP) regulation. Estrogen deficiency during this period leads to increased sympathetic activity, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system, contributing to hypertension and loss of circadian BP rhythm. Despite the high prevalence of hypertension in postmenopausal women, the relationship between menopause, metabolic syndrome, and 24-hour BP variability remains insufficiently explored, particularly in Central Asian populations. This study aimed to compare ambulatory blood pressure monitoring (ABPM) parameters between premenopausal and postmenopausal women with metabolic syndrome to identify alterations in nocturnal BP dipping. A total of 84 women were examined (32 premenopausal, 52 postmenopausal), with 24-hour BP recorded using validated oscillometric devices. Statistical analysis included Student’s t-test, Mann–Whitney U test, and ANCOVA adjustment for age and hypertension duration. The results revealed significantly reduced nocturnal systolic BP dipping in postmenopausal women (4.4 ± 1.5%) compared to premenopausal women (11.3 ± 1.7%, p = 0.011), independent of age and disease duration. These findings indicate a disturbed circadian BP profile linked to hormonal decline, endothelial dysfunction, and increased sympathetic tone. The diminished nocturnal BP reduction underscores a higher cardiovascular risk among postmenopausal women with metabolic syndrome. Regular ABPM should therefore be integrated into hypertension management to guide chronotherapy and optimize night-time BP control. Targeting hormonal pathways and autonomic regulation may provide novel preventive and therapeutic strategies for this vulnerable population.