Blood Pressure Elevation Starts Earlier, Progresses Faster, In Women

In contrast to current thinking, vascular changes such as increased blood pressure (BP) develop earlier and progress faster in women than in men, a longitudinal study suggests

"Our blood pressure trajectories data indicate that women really are different from men when it comes to how we define the health of our blood vessels and how the blood vessels respond to exposures and stressors over the life course," Dr. Susan Cheng of Cedars Sinai Medical Center in Los Angeles told Reuters Health by email.

Dr. Cheng and colleagues analyzed US blood pressure data collected over 43 years from close to 33,000 people (54% female), ages 5 to 98, for a total of 144,599 observations. Measures included systolic BP, diastolic BP, mean arterial pressure, and pulse pressure.

As reported in JAMA Cardiology, when they compared the genders, women had a steeper increase in BP that began as early as the third decade and continued through the life course. After adjustment for multiple cardiovascular disease risk factors—e.g., BMI, total cholesterol, type 2 diabetes, and current smoking—the rates of increase for all BP measures were attenuated for both sexes, as expected, when compared with unadjusted BP trajectories; nonetheless, trajectories remained higher in women than in men over the life course.

Trends were similar in secondary analyses stratified by race/ethnicity, cohort, and antihypertensive medication use. However, as expected, further analyses showed that the incidence of new-onset hard cardiovascular events was higher in men than in women (29.7% vs. 20.5%).

Dr. Cheng said, "We all need to work on engaging all our patients more on the importance of being aware of blood pressure, keeping an eye on it as a measure of vascular health, and acting appropriately as soon as we see blood pressure levels start to creep up."

"Younger to middle-aged adults especially need to be more aware that high blood pressure is not just a condition of older age—that it can begin at a younger age and, when it does, it is especially important to start treating," she added.

Dr. Nanette Wenger of Emory University School of Medicine in Atlanta, author of a related editorial, commented by email to Reuters Health, "The authors view blood pressure as the most accessible metric of vascular aging, and the accelerated blood pressure increase in women vs men must be considered as a significant contributor to ischemic heart disease and heart failure in later life.."

"Hypertension has more adverse physiologic consequences for women than men and US women are more likely to have uncontrolled hypertension than their male peers.," she said.

"Ischemic heart disease in women is more complex than for men," she noted. "In addition to obstruction of the epicardial coronary arteries, women have non-obstructive atherosclerosis and microvascular disease; the extent to which the microvascular disease relates to the underlying biology of the vasculature, and hypertension, remains unexplored and may offer a clue to therapeutic options."

"Myocardial ischemia remains underdiagnosed and undertreated in women, who require better diagnostic strategies and increased application of evidence-based therapies," she said. "But in addition to sex-specific medical research, women require equal access to high quality, affordable healthcare."

"Cardiovascular health of women can be promoted by raising awareness of policy-makers and legislators of how inequities in research, in prevention and in access to care adversely affect women, their families, their communities and the nation," Dr. Wenger concluded.

The study was funded in part by Gilead Sciences.

—Marilynn Larkin

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