Hypertension in women

Abstract

Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men. Hypertension Research (2012) 35, 148-152; doi:10.1038/hr.2011; published online 1 December 2011Keywords: blood pressure; treatment; women INTRODUCTIONHypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. Blood pressure (BP) is generally higher in men than in women regardless of age. Mean systolic BP in the overall population increases progressively throughout adult life in both men and women. During early adulthood mean systolic BP is higher in men than women, but the subsequent rate of rise in BP is steeper for women than men. Prevalence and severity of hypertension increase markedly with advancing age in women, such that a higher percentage of women than men have high BP after 65 years. 1-5 Furthermore, BP control is more difficult to achieve in older women. Data from the Framingham Heart Study showed gender differences in BP control rates and in the pattern of antihypertensive medications prescribed. 3 An age-related decrease in BP control rates were more pronounced in women than in men. Among the oldest participants with hypertension, only 23% of women (vs. 38% of men) were controlled to BP o140/90 mm Hg. Treatment with thiazide diuretics was also more frequent among women than men (38 vs. 23%). It is unknown whether the age-related decline in BP control among women is related to true treatment resistance because of biological factors or to inappropriate drug choices in the clinical setting.This article discusses practical aspects related to hypertension in women and some topics are discussed in detail in separate articles in this special review edition.

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

“…51 Hypertension prevalence is less in women than in men until 45 years of age, is similar in both sexes from 45 to 64 years of age, and is much higher in women than men Ͼ65 years of age. 52 Age-adjusted hypertension prevalence, both diagnosed .…”

“…58 -64 Conversely, there is strong evidence from prospective longitudinal studies that menopause-related BP elevation is dependent on increased body mass index (BMI) and aging, rather than ovarian failure, per se. 51,62 The pathophysiology of the menopause-related increase in BP has been inferred from studies in animals 65,66 and human subjects. 58 Endothelial dysfunction, increased arterial stiffness, activation of RAAS, increased salt sensitivity, oxidative stress, obesity, and genetic factors have been implicated.…”

Hypertension in the elderly

“…After the age of 60 years, the majority of women (age 60-79 years: 48.8%; age ≥ 80 years: 63%) has stage 2 hypertension (BP ≥ 160/100 mmHg) or receives antihypertensive therapy [7][8][9] . Furthermore, BP control is difficult to achieve in elderly women [10] . Endothelial dysfunction, increased arterial stiffness, obesity, genetic factors, elevated total cholesterol and low high-density lipoprotein cholesterol levels have been implicated in menopause-related BP elevation rather than ovarian failure per se [11,12] .…”

Reply to ‘What leads to healthy ageing and longevity?’

“…In addition, the prevalence of hypertension may increase more among women than men in adulthood (4) . Yet in Chen et al's study, women did much more cooking than men.…”