Sex differences in blood pressure regulation and hypertension: renal, hemodynamic, and hormonal mechanisms

Abstract

The teleology of sex differences has been argued since at least as early as Aristotle's Generation of Animals over 300 years BC. While the question "why are the sexes different" remains a topic of debate in the present day in Metaphysics, the recent emphasis on sex comparison in research studies has led to the question "how are the sexes different" being addressed in health science through numerous observational studies in both health and disease susceptibility, including blood pressure regulation and hypertension. These efforts have resulted in better understanding of differences in males and females at the molecular level that partially explain their differences in vascular function and renal sodium handling, and hence blood pressure and the consequential cardiovascular and kidney disease risks in hypertension. This review will focus on clinical studies comparing differences between men and women in blood pressure over the lifespan and response to dietary sodium, and will highlight experimental models investigating sexual dimorphism in the renin angiotensin-aldosterone, vascular, sympathetic nervous and immune systems, endothelin, the major renal sodium transporters/exchangers, and the impact of sex hormones on these systems in blood pressure homeostasis. Understanding the mechanisms governing sex differences in blood pressure regulation could guide novel therapeutic approaches in a sex-specific manner to lower cardiovascular risks in hypertension and advance personalized medicine.

Hypertension, Neurodegeneration, and Cognitive Decline

“…At present, most animal studies have been performed in young males. 88 Given that age and sex modulate the development and expression of hypertension in the AngII, SHR, Dahl salt-sensitive, and DOCA-salt models, 173 future research into the influence of these factors on neurovascular and cognitive dysfunction in hypertension would be illuminating and relevant to the human disease, which affects mainly aged individuals of both sexes. These are a few of the outstanding questions that remain to be addressed.…”

Neural Circuits Underlying Reciprocal Cardiometabolic Crosstalk: 2023 Arthur C. Corcoran Memorial Lecture

“…Most of the work discussed above was performed in male animals, whereas sexual dimorphism in autonomic, cardiovascular, and metabolic physiology and disease susceptibility is well established. [139][140][141] Brain-mediated coordination of cardiometabolic crosstalk enables the rapid and appropriate adjustments that are necessary to maintain the overall homeostasis of the body in the face of changes in internal and external demands and disturbances. However, little is known about the neural pathways involved in the transduction of the sensory and vagal signals that emanate from peripheral metabolic and cardiovascular organs and how the information is processed in the brain to evoke a response.…”

Investigation of the molecular mechanism of Smilax glabra Roxb. in treating hypertension based on proteomics and bioinformatics

“…The parameters were measured thrice, and the average value was obtained. The experiment was performed according to the manufacturer’s instructions ( Drury et al, 2024 ).…”