Gender Differences in Hypertension Treatment, Drug Utilization Patterns, and Blood Pressure Control Among US Adults With Hypertension: Data From the National Health and Nutrition Examination Survey 1999-2004

Abstract

789articles nature publishing group Background National guidelines recommend the same approach for treating hypertensive men and women. It is not known, however, whether current US antihypertensive medication utilization patterns and the resulting degrees of blood pressure (BP) control are similar or different among hypertensive women and men. MethodsThe study was a cross-sectional, nationally representative survey of the noninstitutionalized civilian US population. Persons aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were classified as hypertensive based on a BP ≥140/90 mm Hg, currently taking antihypertensive medication, or having been diagnosed by a physician. results Among hypertensives, the prevalence of antihypertensive medication use was significantly higher among women than men (61.4% vs. 56.8%), especially among middle-aged persons (40-49 years, 53.1% vs. 42.7%) and among non-Hispanic blacks (65.5% vs. 54.6%). Also, treated women were more likely than men to use diuretics (31.6% vs. 22.3%) and angiotensin receptor blockers (11.3% vs. 8.7%). Among treated hypertensives, the proportion taking three or more antihypertensive drugs was lower among women than men, especially among older persons (60-69 years: 12.3% vs. 19.8%, 70-79 years: 18.6% vs. 21.2%, and ≥80 years: 18.8% vs. 22.8%). Only 44.8% of treated women achieved BP control vs. 51.1% of treated men. conclusionsHypertensive women are significantly more likely to be treated than men, but less likely to have achieved BP control. Additional efforts may be needed to achieve therapeutic goals for the US hypertensive population, especially for hypertensive women.

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

“…However, in only 50% of trials, patients actually reached this goal. 19 Recent data from NHANES (1999)(2000)(2001)(2002)(2003)(2004) shows that approximately 30% of patients were treated with two drugs and 15% of patients with three or more antihypertensive drugs, and no gender differences could be detected; 20 findings that were also confirmed by a recent cross-sectional US-survey in about 12 000 patients treated in the primary care setting. 21 Our data do not show gender disparities in the usage of antihypertensive drug combination therapy and indicates, that physicians obviously apply international treatment guidelines equally well to men and women, irrespective of the presence or absence of controlled BP.…”

“…However, significantly less ACE-Is as monotherapy, but more thiazides (monotherapy and combination therapy) and b-blockers (monotherapy) were prescribed in women, data that have been described by other groups. 11,[20][21][22] These findings might be partly explained by the threefold increased risk of women to develop ACE-inhibitor-related cough or potential beneficial effects of thiazides on bone density in postmenopausal women. 23,24 Furthermore, safety concerns in prescribing ACEs to women of childbearing age might have contributed to the lower number of ACE-inhibitor prescriptions.…”

Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

“…18 Better control of hypertension in women contrasts with an American study in which this was instead seen in men. 19 Different factors were important for hypertension control in men and women and four gender interactions were found, adding to the bulk of evidence of sex differences in hypertension. 7,9,20,21 Gender differences are common in cardiovascular medicine, which has, for example, led to separate Framingham 10-year risk equations in men and women.…”

Mortality Risk Associated With Resistant Hypertension Among Women: Analysis from Three Prospective Cohorts Encompassing the Spectrum of Women's Heart Disease

“…[9][10][11][12][13][14][15][16] Consequently, RH has been identified as a priority research area. 7,17 Multiple lines of empiric evidence suggest that women are at greater risk of developing RH than men: mean BP is demonstrably higher in postmenopausal women than agematched men 18 ; women are more likely than men to be treated with antihypertensive drugs, but less likely to achieve BP control 1,6,[19][20][21][22] ; and female sex has been repeatedly identified as an independent predictor of RH. 6,[11][12][13]23,24 Yet, most studies of RH-associated outcomes have enrolled comparatively few women, 17 consistent with CV studies in general.…”