Hemodynamic and hormonal patterns of untreated essential hypertension in men and women

Abstract

Background Knowledge of hemodynamic factors accounting for the development of hypertension should help to tailor therapeutic approaches and improves blood pressure control. Few data exist regarding sex differences of hemodynamic factors contributing to hypertension progression among untreated non-diabetic prehypertensive (PreHyp), Stage I and II subjects as define by the Joint National Commission-7 guidelines (JNC-7). Methods We utilized non-invasive impedance cardiography, applanation tonometry, and plasma measures of angiotensin II, angiotensin-(1-7), serum aldosterone, hs-C reactive protein, and cytokine biomarkers of inflammation to characterize the hemodynamic and hormonal profile of 100 untreated hypertensive subjects (39 females). Results Despite there being no differences between females and males in terms of office blood pressure, heart rate, and body mass index, males demonstrated lower values of pulse pressure, systemic vascular resistance, brachial artery pulse wave velocity, and augmentation index. In each of the three hypertension categories, the increased blood pressure in males was associated with significant augmentations in stroke volume and cardiac output when compared to females. Sex related hemodynamic differences were associated in females with higher plasma levels of leptin, hs-C-reactive protein, plasma angiotensin II, and serum aldosterone and no differences in the serum concentrations of cytokinins. In women but not men, hs-C reactive protein correlated with plasma concentrations of TGF-β1 and body weight, in addition, plasma TGF-β1 correlated with levels of serum VCAM-1. Conclusions The impact of sex differences in the hemodynamic factors accounting for the elevation in arterial pressure in essential hypertensive subjects has been poorly characterized or this information is not available. We suggest that this gap in knowledge may adversely influence choices of drug-treatment since our study shows for the first time significant differences in the hemodynamic and hormonal mechanisms accounting for the increased blood pressure in women compared to men.

Sex determines cardiovascular hemodynamics in hypertension

“…We confirmed the previous observations that women, having comparable brachial BP, characterized with higher CBP than men. 3,12,13 The differences concerned CSBP and CPP, whereas CDBP was not influenced by sex. Peripheral amplification of systolic BP and PP in women, expressed as brachial to central difference, was almost half of this reported in men.…”

“…6 Although women with AH are more aware of the need of treatment and visit physicians more frequently 2 they do not reach satisfactory control of BP. 3 The question whether, and how, the antihypertensive therapy should be sex-adjusted remains without satisfactory answer.…”

“…It results in the acceleration of cardiovascular remodeling and steeper increase of cardiovascular risk. [1][2][3][4] It can be explained by the change of female hormonal status and the loss of cardiovascular protection provided by estrogens in premenopausal women. [4][5][6] In addition, hypertensive females, even in the absence of large coronary artery disease and left ventricular systolic dysfunction, tend to experience more symptoms related to AH, including impaired exercise tolerance and chest pain.…”

Personalized Management of Cardiovascular Disorders

“…A study contradicted the previous medical belief that the impact of HPN is the same in both sexes and concluded that a high BP may be significantly more dangerous in women than in men [45] . Knowledge of the hemodynamic factors that account for the development of HPN should help to tailor therapeutic approaches and improve BP control.…”

Recidivism to uncontrolled blood pressure in patients with previously controlled hypertension

“…20,21 In addition, recent data identify accelerated vascular disease in women compared with men for the same range of uncontrolled HT. 22 Although the mechanisms and impact of gender differences on HT control are not fully known, these data support the concern that poor BP control in aging females may have long-term effects that vary from men. Our data suggest that BP recidivism is a more common finding in elderly women.…”