Hypertension in women

Abstract

Essential hypertension presents itself differently in men and women. Before the menopause, there are obvious hormonal differences between the sexes and it is now known that after the menopause, the arterial tree ages differently. At all ages, the shorter stature in women and the obligatory shorter arterial tree induce faster heart rates and earlier reflected arterial pulse waves. These factors operate to influence systolic blood pressure (BP), pulse pressure (PP), PP amplification, diastolic time, and diastolic BP. The circulatory effects of these variables in youth and with aging help to explain the time dependent and aging differences in cardiovascular risk between men and women. The development of left ventricular hypertrophy, isolated systolic hypertension, and the complications after acute myocardial infarction are also explicable in part by these gender-specific hemodynamic factors. Gender differences are also demonstrable in epidemiologic studies. Although an increased systolic BP is a cardiovascular risk in both sexes, a U-shaped curve describes the diastolic BP risk relationship in men but not in women. There is also a difference in the response to antihypertensive therapy, with a lesser benefit for women in heart disease prevention. These findings raise many remaining unanswered questions. Do some antihypertensive agents have gender-specific effects? Are the dose-response curves different for individual drugs or drugs in combination? Should therapeutic targets for systolic BP, diastolic BP, or PP differ between the sexes? Future answers to such questions would reduce the therapeutic trial and error now necessary for the selection of an individual patient's antihypertensive regimen.