Sex differences in arterial hypertension

Abstract

There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.

Sex-Specific Features of the Correlation between GWAS-Noticeable Polymorphisms and Hypertension in Europeans of Russia

“…Large-scale epidemiological studies indicate the presence of visible men-women differences in BP [2,6,8,82,89,90]. At that, these differences were more noticeable in high-income countries and those in Central/Eastern Europe than in the countries of other regions [89].…”

“…Together with this, an important value in the HTN susceptibility is played by sex hormones, which, firstly, are directly involved in the process regulation of vasoconstriction/vasodilation [90][91][92][93]; secondly, they have a pronounced influence on a number of cardiovascular/HTN risk factors (distribution of adipose tissue in the body, the development of obesity and metabolic syndrome, the formation of obesity-dependent/independent insulin resistance, etc.) [7]; thirdly, they can be significant "modifiers" in the phenotypic manifestation of potential genetic determinants of HTN by modulating various nuclear and extra-nuclear pathways that control the expression of multiple genes, post-translational modifications of protein molecules, various HTN-impact signaling pathways, etc.…”

Increase in Registered Acute Kidney Injuries in German Hospitals

“…Additionally, Hoste et al found hypertension and liver failure to be risk factors for AKI in hospitalized patients [29]. Both factors are especially prevalent in males and could be other causes for the gender disparities in AKI incidence [30,31]. The direct and indirect influence gender has on the risk of AKI is highly complex and warrants further research to advance gender-specific personalized care and prevention.…”

Hoher Blutdruck bei Frauen – geschlechtsspezifische Besonderheiten

“…Unter Diuretika entwickeln Frauen häufiger Elektrolytstörungen (Hyponatriämie und Hypokaliämie) ▶ Tab. 3 Hypertonie-Interventionsstudien mit Auswertung der Ergebnisse, stratifiziert nach Geschlecht (nach Daten aus [31]).…”

“…Männer entwickeln häufiger eine Gicht unter Diuretika und eine sexuelle Dysfunktion, insbesondere bei Betablockern.Kritik an SPRINTDie amerikanische SPRINT-Studie[38] ist zurechtinsbesondere in Europakritisiert worden und hat hier nicht zur Herabsetzung des Zielblutdrucks in den europäischen Leitlinien geführt, im Gegensatz zu den in den USA gültigen. Der Anteil der Frauen in SPRINT war zu gering, um insbesondere bei älteren Frauen den Profit einer intensiven Blutdrucksenkung zu belegen[31,39]. Zudem kommen 2 Subgruppenanalysen zu unterschiedlichen Ergebnissen[40,41]!…”