Hypertension and Pharmacological Therapy in Women
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REVIEW ARTICLE
Hypertension and Pharmacological Therapy in Women Elisa Lodi1 • Alberto Carollo1 • Valentina Martinotti1 • Maria Grazia Modena1
Received: 26 February 2018 / Accepted: 21 March 2018 Springer International Publishing AG, part of Springer Nature 2018
Abstract Cardiovascular (CV) disease is the leading cause of morbidity and mortality for women all over the world. The role and weight of risk factors in relation to gender are not completely clarified as well as their treatment. Pathophysiology of hypertension in woman presents different aspects in relation to phase of life, with an impact on treatment. The only certainties that we have nowadays regarding hypertension therapy in women are really few and may be summarized in: how to treat or, better, what not to use in hypertension in pregnancy and how to treat acute severe hypertension in pregnancy. We have some certainties also on treatment of hypertension associated to some women’s comorbidities. Considering guidelines and analyzing what happens in the real world, we report in this review that women have similar major CV risk factors of men, although a minor CV global risk. However, there are some data that suggest that hypertension and diabetes are more important risk factors in women than in men. Blood pressure reduction and benefit by treatment appear similar in women and men, suggesting that we should aim for similar target of blood pressure, although the lower global risk profile should imply different target. Theoretically, recommended drugs are similar in women and men, but in women we must take in account CV risk profile, comorbidity, side effects, and reproductive health. Finally, registries and observational studies show that fewer women reach the target values of blood pressure and that women receive more frequently prescription of ‘‘other’’ classes of drugs than those recommended by guidelines, even after normalization by age and comorbidities. & Maria Grazia Modena [email protected] 1
University of Modena and Reggio Emilia, Modena, Italy
Keywords Hypertension Gender medicine Women Anti-hypertensive drugs
1 Introduction Cardiovascular (CV) disease is the leading cause of morbidity and mortality for women all over the world. The role and weight of risk factors in relation to gender are not completely clarified as well as their treatment, except for lifestyle’s modification which is the common soil either in men as well as in women for first pass therapy of all diseases. Guidelines do not clearly identify differences in relation to gender, but the therapeutic response depends on the interaction between genes, environment and culture; therefore, it is important to define the concepts of sex and gender. Sex includes everything related to biology (genes, hormones, etc.), while the concept of gender, brought to the biomedical and human sciences, includes cultural, environmental and social influences [1]. In particular, pathophysiology of hypertension in women presents different aspects in relation to phases of life, with a
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