Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

Abstract

While left ventricular (LV) structure and function differ between hypertensive women and men, it remains unclear whether sex affects regression of LV hypertrophy with antihypertensive treatment. We analysed paired echocardiograms in 500 men and 347 women enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study at baseline and after 12 months of antihypertensive treatment with either losartan or atenolol. At enrolment, 177 women and 242 men were randomized to losartan-based treatment and 161 women and 247 men were randomized to atenolol-based treatment (sex difference ¼ NS). After 12 months of antihypertensive treatment, blood pressure was lowered similarly in women (152/83 from 174/97 mmHg) and men (149/85 from 173/99 mmHg; both Po0.001, sex difference ¼ NS), without significant change in body weight in either sex. Cardiac output and pulse pressure/stroke volume were equivalently reduced in both sexes (À0.2 vs À0.1 l/min and both -0.20 mmHg/ml/m 2 , respectively; both P ¼ NS). Absolute LV mass change after 12 months of antihypertensive treatment was greater in men than in women (À30 vs À24 g, P ¼ 0.01). However, after adjusting for baseline LV mass and randomized study treatment, LV mass reduction was greater in women than in men (À33 vs À23 g, P ¼ 0.001). LV mass regression was greater in women, by 8.072.8 g, after adjusting for baseline LV mass and randomized study treatment. After consideration of baseline LV mass and randomized study treatment, antihypertensive treatment regressed LV hypertrophy more in women. Further studies are needed to identify the mechanisms and prognostic implications of this sex-related difference.

Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden

“…Antihypertensive therapy, however, has been shown to have a better effect on left ventricular mass regression in hypertensive women than in corresponding men [28]. Female sex hormones are assumed to have a cardiovascular protective effect, although intervention data on the effect of hormone replacement therapy do not support this [29].…”

Cardiac Resynchronization Therapy:

“…Olivetti et al 30 demonstrated that aging in men, but not in women, causes significant myocyte cell loss, reactive cells hypertrophy, and a change in the proportion of mono‐ and binucleate myocyte. In pathologic situations, such as aortic stenosis 31,32 and essential hypertension, 33,34 women exhibit a more concentric remodeling with preserved systolic function. In this respect, the presence of hypertrophic reserve in females was verified in an experimental model by Tamura et al 35 …”

Outcomes in Women Undergoing Electrophysiological Procedures

“…60 Several studies have shown gender difference in physiological and pathological remodelling associated with different cardiovascular diseases. [61][62][63] In addition, in failing human hearts, Guerra et al demonstrated that the female heart is protected, at least in part, from necrotic and apoptotic death. 64 Based on these observations, it is possible that female patients have a more favourable substrate for reverse remodelling during CRT.…”