OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death for women globally, and menopause is associated with elevated morbidity and mortality. The total impact of menopause on blood pressure remains inconclusive, with evidence largely based on data from industrialized populations. To address this gap, we examined associations between menopause, blood pressure, and hypertension among Tsimane forager-horticulturalists and compared results against a nationally representative US sample to assess population-level differences in blood pressure with menopause. MATERIALS AND METHODS: We analyzed data from female and male Tsimane (nindividuals = 5,570; nobservations = 18,676; ages 15-92) and US National Health and Nutrition Examination Survey participants (NHANES; nindividuals = 6,861; ages 16-80). We applied linear regression models to assess age and population effects on systolic (SBP) and diastolic blood pressure (DBP) with menopause, logistic regression models for hypertension and stage 2 hypertension, and mediation analyses with estradiol. RESULTS: SBP age trajectories were higher (b = 0.002, p < 0.001) and DBP trajectories lower (b = -0.004, p < 0.001) following menopause. Compared to US women, Tsimane women's SBP increased more quickly with age (b = 0.001, p = 0.021), while DBP decreased less dramatically (b = 0.003, p < 0.001). Postmenopause individuals had lower odds of hypertension with age compared to premenopausal women. Estradiol did not mediate blood pressure effects of menopause. DISCUSSION: We found similar associations between menopause and blood pressure in both populations, despite widely differing CVD risk environments. However, Tsimane women showed slightly different pressure changes with age postmenopause. These results indicate blood pressure change postmenopause may be universal, but premenopause CVD risk environments may impact postmenopause CVD risk outcomes.