Gender Differences in Antihypertensive Treatment: Myths or Legends?
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REVIEW ARTICLE
Gender Differences in Antihypertensive Treatment: Myths or Legends? Maria Lorenza Muiesan1 • Massimo Salvetti1 • Claudia Agabiti Rosei1 Anna Paini1
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Received: 20 February 2016 / Accepted: 12 April 2016 Ó Springer International Publishing Switzerland 2016
Abstract In European countries and in the USA, hypertension represents an important risk factor for cardiovascular diseases (CVD) in men and women. Women do not perceive CVD as an important health problem, despite the evidence that women are more at risk to die from hypertension-related CVD than men. A correct prevention strategy should more widely acknowledge sex-specific risk factors, such as hypertension in pregnancy, and the benefit of treating hypertension in both men and women. In more recent years, hypertension awareness and treatment rates are higher in women than in men while blood pressure control rates are improving, but remain still lower in older hypertensive women. Differences have been described regarding the pattern of antihypertensive drug prescription and use in hypertensive men and women; women are more frequently treated with diuretics and less frequently with angiotensin-converting-enzyme (ACE)-inhibitors and angiotensin-receptors blockers. Calcium-antagonists appear to be particularly effective in women. Data from large clinical trials and meta-analyses offer strong evidence that the efficacy of the various drug classes in prevention of CV events does not differ by sex, and therefore the choice of the drug cannot be based only on this criterion in postmenopausal women. There are currently no specific blood pressure (BP) treatment goals for post-menopausal hypertension.
& Maria Lorenza Muiesan [email protected] 1
Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Internal Medicine c/o 2a Medicina, Spedali Civili, 25100 Brescia, Italy
Keywords sex Gender Women Hypertension Blood pressure Treatment
1 Introduction In European countries and in the USA, hypertension represents an important risk factor for CVD in men and women. Women do not perceive CVD as an important health problem, despite the evidence that women are more at risk to die from hypertension-related CVD than men [1]. The poorer outcome observed in women may be related, at least in part, to the wrong perception by both patients and physicians that women are at substantial lower risk than men [2]. Acknowledgement of risk factors that are unique for women, such as hypertension in pregnancy [3] and a proper information on the benefit of treating hypertension should be more widely spread to prevent a number of hypertension-related events in women. In the Cardiovascular Lifetime Risk Pooling Project the cumulative lifetime risk of cardiovascular disease, coronary heart disease, and stroke adjusted for competing risk of non-cardiovascular disease death by blood pressure category for men and women was calculated [4]. A total of 61,585 men and women were followed from the age of 55 and contributed about 700,000
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