Gender Differences in the Regulation of Blood Pressure

Abstract

Abstract-Men are at greater risk for cardiovascular and renal disease than are age-matched, premenopausal women.Recent studies using the technique of 24-hour ambulatory blood pressure monitoring have shown that blood pressure is higher in men than in women at similar ages. After menopause, however, blood pressure increases in women to levels even higher than in men. Hormone replacement therapy in most cases does not significantly reduce blood pressure in postmenopausal women, suggesting that the loss of estrogens may not be the only component involved in the higher blood pressure in women after menopause. In contrast, androgens may decrease only slightly, if at all, in postmenopausal women. In this review the possible mechanisms by which androgens may increase blood pressure are discussed. Findings in animal studies show that there is a blunting of the pressure-natriuresis relationship in male spontaneously hypertensive rats and in ovariectomized female spontaneously hypertensive rats treated chronically with testosterone. The key factor in controlling the pressure-natriuresis relationship is the renin-angiotensin system (RAS). The possibility that androgens increase blood pressure via the RAS is explored, and the possibility that the RAS also promotes oxidative stress leading to production of vasoconstrictor substances and reduction in nitric oxide availability is proposed. Key Words: sex characteristics Ⅲ hypertension Ⅲ angiotensin II Ⅲ nitric oxide Ⅲ oxidative stress I n this review gender differences in blood pressure control are explored, including possible mechanisms by which androgens may increase blood pressure. Gender Differences in Blood Pressure Regulation in HumansMen are generally at greater risk for cardiovascular and renal disease than are age-matched, premenopausal women. Recent studies using the technique of 24-hour ambulatory blood pressure monitoring have shown that blood pressure is higher in men than in women at similar ages. As shown in Figure 1, Wiinber and colleagues 1 studied 352 normotensive (for age) Danish men and women, aged 20 to 79 years, and found that blood pressure increased with aging in both men and women, but that men had higher 24-hour mean blood pressure, by approximately 6 to 10 mm Hg, than did women, until the age of 70 to 79 years, when blood pressure was similar for men and women. Khoury and colleagues 2 performed ambulatory blood pressure monitoring on 131 men and women, aged 50 to 60 years, and found that men had higher blood pressure than did women. Findings were similar in a meta-analysis study performed by Staessen et al. 3 In addition, the Third National Health and Nutrition Evaluation Survey (NHANES III) showed that, in general, men had higher blood pressure than women through middle age. 4 Furthermore, the incidence of uncontrolled hypertension is also greater in men than in women. 5After menopause, however, blood pressure increases in women as well. The data from NHANES III, shown in Figure 2, confirmed that by 60 to 69 years of age, non-Hispanic black and Hi...

Sex difference in blood pressure among South Asian diaspora in Europe and North America and the role of BMI: a meta-analysis

“…3,5 The mechanisms underlying the sex difference in BP are not well understood, but sex hormones have been suggested as a possible cause. [6][7][8] The favourable position among women in terms of BP and hypertension is not as clearly observed in South Asian descent populations compared with others. For example, in the Hindustani-Surinamese of South Asian descent, we did not observe a sex difference in hypertension.…”

Serum calcium revisited: associations with 24-h ambulatory blood pressure and cardiovascular reactivity in Africans

“…2,6 In addition, serum calcium tends to increase with age only in women, 5 while blood pressure increases with age in both genders, 7 although the increase is less pronounced in women. 8 Kesteloot and Geboers 2 also noticed that the blood pressure-serum calcium relationship was stronger in younger compared with older men. More recently, elevated serum calcium was found to be a predictor, 9 as well as an independent prospective risk factor, 10 for myocardial infarction in middle-aged men.…”

Hormonal effects on blood vessels

“…The incidence of cardiovascular diseases (CVDs), such as hypertension and coronary artery disease, is lower in younger women than in men of the same age. [3][4][5] However, it rises after menopause and, with age, catches up to that among men. These phenomena have been explained by the atheroprotective action of endogenous estrogen and its deprivation in postmenopausal women.…”