Hypertension in women
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Corresponding author Sandra J. Taler, MD Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2008, 2:239 –244 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2008 by Current Medicine Group LLC
Systolic blood pressure is higher in African American and Hispanic women older than 60 and in white women older than 70 than it is in men. Coupled with their longer survival, elderly women have higher hypertension prevalence rates, particularly for isolated systolic hypertension. Hemodynamic characteristics differ by sex for premenopausal women and age-matched men, but these differences lessen after menopause. This transition may result from hormonal or metabolic alterations, including weight gain and tissue adiposity, which are common after menopause. Clinical trials enrolling large numbers of women support the benefits of treatment to reduce cardiovascular events and mortality. The trend to enroll subjects with several comorbidities and thereby increase event rates may limit the applicability of trial results to healthier women. Women appear more prone to develop side effects from antihypertensive medications and may metabolize these agents differently. There is a need for additional studies regarding appropriate drug selection, dosage, and combination therapy for women.
Introduction As a group, women develop hypertension at later ages than men. Within Western societies, blood pressure rises with advancing age. Population studies demonstrate a progressive rise in systolic blood pressure into the seventh decade for both sexes, whereas diastolic pressure plateaus in the fi fth decade and then declines [1]. Over age 60 for African Americans and Hispanics and 70 for whites, systolic blood pressure is higher in women [2•]. Coupled with their longer survival, elderly women have higher hypertension prevalence rates, particularly for isolated systolic hypertension. In a cohort of middle-aged premenopausal and perimenopausal women (mean age, 46 years), Hispanics were twice as likely and African Americans three times more likely to have
hypertension than whites [3]. Beyond race or ethnicity, covariates independently associated with hypertension in this cohort included other components of the metabolic syndrome: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, and hyperglycemia. Data from the National Health and Nutrition Examination Survey (NHANES) historically have revealed that women are more likely than men to be aware of their hypertension and to be receiving treatment but are less likely to have their hypertension controlled. Awareness and treatment rates increased in the 2003–2004 survey, but the changes were not significant compared with rates in 1999–2000 [2•]. Control rates among all persons with hypertension increased from 29.2% in 1999–2000 to 36.8% in 2003–2004, but control rates for treated persons did not change. By sex and race/ethnicity subgroups, control
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