Hypertension is worldwide the most deadly risk factor in women. The rise in blood pressure often starts around 50 years of age when women enter menopause. The rise in blood pressure may provoke a variety of symptoms that are often attributed to menopause. This may be one of the reasons that often no treatment is given. There is increasing evidence that end organ damage is more severe in hypertensive women than men, look for instance at the high prevalence of HFpEF in elderly women. As the ‘optimal treatment’ for HFpEF is prevention at middle-age, there needs to be a focus on better surveillance in this age group.