Antihypertensive drug therapy and blood pressure control in men and women: an international perspective

Abstract

Cardiovascular death represents the single largest cause of mortality in women with 70% of deaths attributable to modifiable risk factors, such as hypertension. This analysis aims at evaluating, whether there are gender disparities in antihypertensive drug usage and blood pressure (BP) control. We included 18 017 patients with arterial hypertension from the International Survey Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension (I-SEARCH). The study was conducted between September 2005 and March 2006 in 26 countries, and data on patient demographics, cardiovascular disease and risk factors, BP, and cardiovascular drug treatment were collected. Mean systolic blood pressure (SBP) was 2.1 mm Hg higher in women (150.6 ± 0.35 mm Hg, n ¼ 8357/18 017) than in men (148.5 ± 0.35 mm Hg; Po0.0001, n ¼ 9526/18 017), whereas no difference in diastolic BP was seen (88.2 ± 0.20 vs 88±0.20 mm Hg; P ¼ 0.198). Gender differences in SBP were more pronounced in diabetic as compared with nondiabetic patients (3.5 vs 1.7 mm Hg, n ¼ 4272 vs n ¼ 13 611; Po0.0001) and became evident at an age 55 years old. Overall BP-control rate was 33.6% in men and 30.6% in women (Po0.0001) and was lower in diabetic as compared with non-diabetic patients. In all, 30% of patients used one, 40% used two and 30% used X3 drugs without gender differences. Response rates to different drug regimens appeared to be similar. However, women received more frequently thiazides and b-blockers, and less frequently ACE-inhibitors as monotherapy. Major efforts are required to improve BP-management, especially in women.

Institutional hypertension control in Malaysia: a multicenter study focusing on gender and cardiovascular risk factor profile difference

“…This data mirror earlier data from NHANES (1999)(2000)(2001)(2002)(2003)(2004), which showed a 4 mm Hg higher SBP in women and the recently published I-SEARCH cohort, which showed a 2.1 mm Hg higher mean SBP in women but no difference in DBP. 8,13 Studies have shown that a 2 mm Hg reduction in SBP is associated with a 7% reduction in IHD, IHD mortality and a 10% reduction in stroke mortality. 14 Therefore, a 6.9 mm Hg difference in mean SBP between the genders translates to a 3.5-fold higher risk of IHD and stroke mortality for women in Malaysia.…”

“…6 Although the meta-analysis by Turnbull et al points to comparable blood pressure (BP) control levels for both men and women, other studies have shown poorer control and worse outcomes in women. [7][8][9] This is seen in the increased early mortality and poorer outcomes in women with coronary artery diseases. 10,11 In Malaysia, the NHMS III household survey found that female hypertensives had higher mean systolic BP (SBP) levels and poorer control level compared with men across all major ethnic groups.…”

Gender-specific, multi-level determinants of outcomes of antihypertensive treatment: a sub-analysis of the Belgian PREVIEW study

“…That is, previously identified factors that contribute to poor BP control have included physician-related factors, such as physician age, 17 willingness to accept high BP values 18 and so-called 'therapeutic inertia, ' 19 as well as patient-related factors, including age, 20,21 treatment adherence 22,23 and gender. [24][25][26] An area of clinical interest that has not received attention is whether or not the multi-level determinants of BP control are gender-specific. With significant gender differences in underlying hypertension prevalence, 1 awareness, 21 progression 27,28 and levels of control, 14,24,25 it seems plausible that determinants of BP control also could differ between women and men.…”

The therapeutic importance of home blood pressure assessment and combination antihypertensive therapy for achieving target blood pressure control: Ibaraki hypertension assessment trial

“…Previous reports demonstrate that office BP control was achieved in approximately 20% of hypertensive patients with DM 18,21 and 38% of hypertensive patients without DM. 21 The percentage of patients attaining a target BP was higher in the I-HAT study than in previous reports.…”

“…Previous reports demonstrate that office BP control was achieved in approximately 20% of hypertensive patients with DM 18,21 and 38% of hypertensive patients without DM. 21 The percentage of patients attaining a target BP was higher in the I-HAT study than in previous reports. Mori et al reported that monotherapy was prescribed in 62.3% of patients and office BP control was achieved in approximately 11.3% of hypertensive patients with DM and 32.5% of hypertensive patients without DM.…”