Sex determines cardiovascular hemodynamics in hypertension

Abstract

The aim of this study was to evaluate the influence of sex on cardiovascular hemodynamics and heart remodeling in 144 patients with arterial hypertension that underwent: (1) echocardiography (that is, indices of left ventricular diastolic function: e', E/e'), (2) impedance cardiography (that is, systemic vascular resistance (SVR), total artery compliance (TAC) and Heather index (HI)) and (3) applanation tonometry (augmentation index (AI), central systolic and diastolic blood pressure (CSBP, CDBP), central pulse pressure (CPP)). Women, in comparison with men, revealed to have: (1) stiffer arteries--lower TAC (1.93±0.55 vs 2.16±0.59 ml per mm Hg; P=0.025), higher CSBP (128.7±14.9 vs 123.4±13.2 mm Hg; P=0.036), CPP (39.9±9.5 vs 33.8±9.0 mm Hg; P=0.0002), AI (31.5±8.7 vs 17.5±12.7%; P<0.00001), SVR (1257.6±305.6 vs 1091.2±240.7 dyn × s × cm(-)(5); P=0.002) and (2) higher left ventricular performance--HI (16.3±4.3 vs 11.7±3.2 Ohm × s(2); P<0.00001). In women CSBP, CPP and AI were more clearly associated with left ventricular filling pressure (e') (r=-0.39, r=-0.45, r=-0.44, P<0.01; respectively). These relations were remarkably weaker in men. Hypertensive women characterized with lower large artery compliance, more pronounced augmentation of central blood pressure and more distinctive association of central blood pressure with left ventricular diastolic function. Sex differences in cardiovascular function can impact the individualized management of arterial hypertension.

Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA‐Brasil Study

“…The researchers showed that, even after controlling for ascending aorta diameter, women had greater proximal stiffness, suggesting that sex differences exist in vascular wall properties. A sex difference in arterial stiffness was recently reported by Krzesinski et al, 29 who found that hypertensive women had lower large arterial compliance. We observed that the association between aging and cf-PWV cannot be explained by classic risk factors in brown and mainly in black women in the highest cf-PWV quartile.…”

Sex differences in cardiac and renal responses to a high salt diet in Sprague-Dawley rats

“…The greater increase in troponin I of male rats when compared with female rat in this study may be due to the protective effects of estrogens in the cardiovascular system [16, 32]. Estrogen has been shown to attenuate the development of cardiac hypertrophy and fibrosis through activation of steroid receptors located on myocytes, fibroblasts, and the extracellular matrix [33] and delays the progression of hypertension [34], development of cardiac hypertrophy [35], reduces activation of the renin-angiotensin system [36] and limits fibrosis, in salt-sensitive experimental models [17, 21] and in humans [37].…”

The hemodynamic patterns in hypertensive men and women of different age

“…In our opinion, it was related to high proportion of premenopausal women and sex-dependent differences in systemic hemodynamics, which we discuss in detail elsewhere. 23 The observed decreasing trend in O/C ratio might be associated with age-related reduction in the early LV filling. 29,30 Our previous observations also confirmed that O/C ratio was correlated with mitral flow parameters such as: E, A and E/A (r = 0.40, − 0.22 and 0.44, respectively; P o0.05 for all) (Krzesiński et al, data unpublished).…”

“…It can be explained by relatively higher augmentation of central blood pressure, which results in impaired compliance of aorta, together with lower constriction of medium and small vessels protected by the action of estrogens and maintained by the production of nitric oxide. 8,9,23,24 Aging and LV systolic function Most studies reports limited influence of aging on LV systolic function assessed by echocardiography. 2,7,20,25,26 Similarly, we did not observe significant change in LVEF, but some authors noted that with more detailed techniques, such as two-dimensional strain, age-related decrease in LV contractility may be observed.…”