Sex Differences in Arterial Hypertension: Key Points

Gerdts E, Sudano I, Brouwers S, et al.
Sex Differences in Arterial Hypertension: A Scientific Statement From the ESC Council on Hypertension, the European Association of Preventive Cardiology, Association of Cardiovascular Nursing and Allied Professions, the ESC Council for Cardiology Practice, and the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J 2022;Sep 22:[Epub ahead of print].

The following are key points to remember from this European scientific statement on sex differences in arterial hypertension:

  1. Although there are limited clinical trial data evaluating sex-specific effects of hypertension, recent data indicate that risk for cardiovascular complications starts at lower blood pressure (BP) levels in females than in males.
  2. Healthy young females have lower BP than males at a similar age but experience a steeper increase in BP from the third decade of life.
  3. The role of autonomic and endocrine BP regulators differs between sexes and may influence drug efficacy and adverse effects.
  4. Lower estrogen level after menopause is related to both upregulation of hormonal systems such as the renin-angiotensin-aldosterone system and sympathetic nervous system, and to reduced vascular nitric oxide bioavailability.
  5. Females with hypertension more often develop atrial fibrillation and heart failure with preserved ejection fraction, while males more often develop acute myocardial infarction and heart failure with reduced ejection fraction.
  6. In general, males treated for hypertension achieve better BP control than females.
  7. Females more often report adverse effects from antihypertensive drugs than males, except for mineralocorticoid receptor antagonists.
  8. It is not yet known whether hypertension including treatment goals and choice and dosages of antihypertensive drugs should be managed differently in men and women.
  9. Future clinical studies should explore whether using sex-specific BP threshold values and treatment targets in hypertension may improve cardiovascular disease prevention.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Acute Coronary Syndrome, Antihypertensive Agents, Atrial Fibrillation, Autonomic Agents, Blood Pressure, Estrogens, Heart Failure, Hypertension, Menopause, Mineralocorticoid Receptor Antagonists, Myocardial Infarction, Nitric Oxide, Primary Prevention, Renin-Angiotensin System, Sex Characteristics, Stroke Volume, Sympathetic Nervous System

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