Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials

Turnbull, Fiona; Woodward, Mark; Neal, Bruce; Barzi, Federica; Ninomiya, Toshiharu; Chalmers, John; Perkovic, Vlado; Li, N.; MacMahon, Stephen

doi:10.1093/eurheartj/ehn427

Cited by 227 publications

(169 citation statements)

References 55 publications

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“…31 However, a meta-analysis of data from 31 trials involving more than 100 000 male and nearly 90 000 female patients with hypertension found no evidence of a difference in the effects of BP-lowering treatment regimens between men and women. 21 In this study, there were no differences across subgroup categories in the incidence or type of adverse effects. Full tolerability data from this trial were previously reported 17 and were consistent with the safety profiles of angiotensin receptor blocker/calcium channel blocker combinations described in the literature.…”

Section: Discussionmentioning

confidence: 49%

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Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Schmieder

Böhm

2010

J Hum Hypertens

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Effective antihypertensive therapy is crucial for preventing cardiovascular events; however, blood pressure (BP) control rates remain poor. The objective of this analysis was to determine the efficacy of olmesartan/ amlodipine in age, severity and gender-based subgroups of patients with moderate-to-severe hypertension uncontrolled by amlodipine monotherapy. Patients with uncontrolled BP after 8 weeks' amlodipine 5 mg monotherapy (n ¼ 755) were randomized to continue amlodipine 5 mg or receive olmesartan (10-40 mg) plus amlodipine 5 mg for 8 weeks. Patients whose BP remained suboptimal were uptitrated to olmesartan/ amlodipine 20/5, 40/5 or 40/10 mg. Changes in BP and numbers of controlled patients were calculated separately to assess efficacy in patients aged o65 or X65 years, in those with moderate or severe hypertension, and in males and females. The antihypertensive effects of olmesartan/amlodipine were similar in patients aged o65 and X65 years of age. Compared with patients with moderate hypertension at baseline, those with severe hypertension tended to show higher decreases in BP, but achieved lower goal rates despite this. Females showed larger mean reductions in diastolic (1.61 mm Hg; P ¼ 0.003) and systolic BP (1.72 mm Hg; P ¼ 0.053) than males, independent of age and dose. This gender difference appeared to be higher and more consistent across dose groups for patients o50 years of age, but the difference in the pattern between both age groups was not statistically significant (P ¼ 0.1526). These results suggest that olmesartan/amlodipine is effective and safe in a wide range of patients, regardless of age or hypertension severity. Small differences in responsiveness between females and males may exist, which require further investigation.

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Section: Discussionmentioning

confidence: 49%

“…For example, certain BP-lowering treatment regimens have been reported to differ between men and women, [18][19][20] whereas others have shown no evidence of a gender difference. 21 Also, BP is known to increase with advancing age and it is important to determine that antihypertensive therapies are effective in older patients.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Schmieder

Böhm

2010

J Hum Hypertens

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“…The main objective was to quantify the effects of BP-lowering treatment according to gender and to determine whether there are important differences in the proportional benefits of treatment between women and men. 53 Despite baseline BP levels were slightly higher among women than men, there was no evidence that women and men present different levels of protection from total major CV events (stroke, coronary heart disease events, heart failure and other CV death) from BP lowering. Furthermore, the data showed no evidence of an interaction of sex with BP-lowering treatment for the outcomes of coronary heart disease, heart failure, CV death or total mortality.…”

Section: Gender Considerations In the Treatment Of Hypertensionmentioning

confidence: 94%

Hypertension in women

Pimenta

2011

Hypertens Res

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Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men. Hypertension Research (2012) 35, 148-152; doi:10.1038/hr.2011; published online 1 December 2011Keywords: blood pressure; treatment; women INTRODUCTIONHypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. Blood pressure (BP) is generally higher in men than in women regardless of age. Mean systolic BP in the overall population increases progressively throughout adult life in both men and women. During early adulthood mean systolic BP is higher in men than women, but the subsequent rate of rise in BP is steeper for women than men. Prevalence and severity of hypertension increase markedly with advancing age in women, such that a higher percentage of women than men have high BP after 65 years. 1-5 Furthermore, BP control is more difficult to achieve in older women. Data from the Framingham Heart Study showed gender differences in BP control rates and in the pattern of antihypertensive medications prescribed. 3 An age-related decrease in BP control rates were more pronounced in women than in men. Among the oldest participants with hypertension, only 23% of women (vs. 38% of men) were controlled to BP o140/90 mm Hg. Treatment with thiazide diuretics was also more frequent among women than men (38 vs. 23%). It is unknown whether the age-related decline in BP control among women is related to true treatment resistance because of biological factors or to inappropriate drug choices in the clinical setting.This article discusses practical aspects related to hypertension in women and some topics are discussed in detail in separate articles in this special review edition.

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“…2,3 Whereas recent evidence suggests that the association of blood pressure (BP) and the risk of ischaemic heart disease and stroke is similar in men and women and that BP lowering provides broadly similar mortality benefits, irrespective of the drug regimen used, other data suggest potential gender differences with regard to treatment efficacy. [4][5][6][7] Furthermore, women with known cardiovascular disease or cardiovascular risk factors are less likely to receive guideline-recommended drug therapy as compared with men, and BP-control rates appear to be lower in women at a higher age. [8][9][10][11] As cardiovascular disease is considered to be the single largest cause of mortality in women with 70% of cardiovascular deaths attributable to modifiable risk factors, such as hypertension, it is important to better understand gender disparities in hypertension management on a worldwide basis to ensure equal standards in treatment for both, men and women.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials

Abstract: All of the blood pressure-lowering regimens studied here provided broadly similar protection against major cardiovascular events in men and women. Differences in cardiovascular risks between sexes are unlikely to reflect differences in response to blood pressure-lowering treatments.

Cited by 227 publications

References 55 publications

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

Hypertension in women

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

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