Sex Differences in the Prevalence, Outcomes and Management of Hypertension

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Abstract

Purpose of Review

To review recent data on sex differences in the prevalence, outcomes and management of hypertension.

Recent Findings

Although hypertension is overall more common in males, females experience a much sharper incline in blood pressure from the third decade of life and consequently the prevalence of hypertension accelerates comparatively with age. Mechanisms responsible for these blood pressure trajectories may include the sustained vascular influence of hypertensive disorders of pregnancy, interactions between the renin–angiotensin–aldosterone system and sex hormones or even psychosocial gendered factors such as socioeconomic deprivation. Moreover, the impact of hypertension is not uniform and females are at higher risk of developing a multitude of adverse cardiovascular outcomes at lower blood pressure thresholds.

Summary

Blood pressure is a sexually dimorphic trait and although significant differences exist in the prevalence, pathophysiology and outcomes of hypertension in males and females, limited data exist to support sex-specific blood pressure targets.

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Most cited references 35

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Heart Disease and Stroke Statistics—2020 Update

Salim S. Virani, Alvaro Alonso, Emelia Benjamin … (2020)

Circulation

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Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association

Salim S. Virani, Alvaro Alonso, Hugo Aparicio … (2021)

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.

Salim Yusuf, Steven Hawken, Stephanie Ounpuu … (2004)

Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown. We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated. Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women. Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction.

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Author and article information

Contributors

Christian Delles:

ORCID: http://orcid.org/0000-0003-2238-2612

Christian.Delles@glasgow.ac.uk

Journal

Journal ID (nlm-ta): Curr Hypertens Rep

Journal ID (iso-abbrev): Curr Hypertens Rep

Title: Current Hypertension Reports

Publisher: Springer US (New York )

ISSN (Print): 1522-6417

ISSN (Electronic): 1534-3111

Publication date (Electronic): 7 March 2022

Publication date PMC-release: 7 March 2022

Publication date (Print): 2022

Volume: 24

Issue: 6

Pages: 185-192

Affiliations

GRID grid.8756.c, ISNI 0000 0001 2193 314X, Institute of Cardiovascular and Medical Sciences, , University of Glasgow, ; 126 University Place, Glasgow, G12 8TA UK

Author information

Christian Delles http://orcid.org/0000-0003-2238-2612

Article

Publisher ID: 1183

DOI: 10.1007/s11906-022-01183-8

PMC ID: 9239955

PubMed ID: 35254589

SO-VID: f11ea68b-ff6e-4da9-8fea-5713d71834b1

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date accepted : 8 February 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000274, British Heart Foundation;

Award ID: RE/18/6/34217

Award Recipient : Christian Delles

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: sex,gender,hypertension,blood pressure

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: sex, gender, hypertension, blood pressure

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Sex Differences in the Prevalence, Outcomes and Management of Hypertension

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Abstract

Purpose of Review

Recent Findings

Summary

Related collections

Sex and gender-sensitive medicine

Most cited references 35

Heart Disease and Stroke Statistics—2020 Update

Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.

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Contributors

Journal

Affiliations

Author information

Article

History

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Comments

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Similar content 47

Cited by 28

Most referenced authors 1,562