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Review
. 2022 Dec 7;43(46):4777-4788.
doi: 10.1093/eurheartj/ehac470.

Sex differences in arterial hypertension

Eva Gerdts  1 , Isabella Sudano  2 , Sofie Brouwers  3   4 , Claudio Borghi  5 , Rosa Maria Bruno  6   7 , Claudio Ceconi  8 , Véronique Cornelissen  9 , François Diévart  10 , Marc Ferrini  11 , Thomas Kahan  12 , Maja-Lisa Løchen  13 , Angela H E M Maas  14 , Felix Mahfoud  15 , Anastasia S Mihailidou  16   17 , Trine Moholdt  18 , Gianfranco Parati  19   20 , Giovanni de Simone  21
Affiliations
Review

Sex differences in arterial hypertension

Eva Gerdts et al. Eur Heart J. .

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.

Keywords: Adverse events; Blood Pressure regulators; Cardiovascular disease; Hypertension; Hypertension-mediated organ damage; Pharmacological treatment; Sex; Sex hormones.

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Conflict of interest statement

Conflict of interest: E.G.: Bayer Health, NOKLUS, Fürst laboratories; I.S. Amgen, Astra Zeneca, Daiichi Sankio, Medtronic, Merck Sharpe & Dohme, Novartis, Recordati, Sanofi and Servier; SB Daiichi Sankyo; Merck, Sanofi, Menarini and Servier; C.B. Menarini Corporate, Servier, Novo Nordisk and Novartis; R.M.B. Medtronic; C.C.: none; V.C.: none; F.D.: none; M.F.: none; T.K.: TK Medtronics, and ReCor Medical; M.L.L.: Bayer Health, Sanofi, Bristol Myers Squibb and Pfizer; AHEMM: Organon, Novartis, Abbott and Omron; F.M.: Medtronic, ReCor Medical, Astra-Zeneca, Bayer, Boerhringer-Ingelheim, Medtronic, Merck and ReCor Medical; A.S.M.: Servier and SCAI; T.M.: none; G.P.: none; G.d.S.: none.

Figures

Graphical Abstract
Graphical Abstract
Sex differences in hypertension. BP, blood pressure; CV, cardiovascular; T2D, type 2 diabetes; OSAS, obstructive sleep apnoea syndrome; LVH, left ventricular hypertrophy; LV, left ventricular; LA left atrial; HFpEF, heart failure with preserved ejection fraction; BB, beta blocker; CCB, calcium channel blocker; HFrEF, heart failure with reduced ejection fraction.
Figure 1
Figure 1
Blood pressure development in females and males during childhood, adolescence, and early adulthood. Based upon O’Keeffe et al., Shen et al., and Ji et al..
Figure 2
Figure 2
Sex differences in development of arterial dysfunction and related complications. Red arrows indicate mechanisms that are enhanced in females. MBP, mean arterial blood pressure; PP, pulse pressure; DBP, diastolic blood pressure; LVH, left ventricular hypertrophy; HFpEF, heart failure with preserved ejection fraction; AMI, acute myocardial infarction; AF, atrial fibrillation; RAAS, renin-angiotensin-aldosterone system; NO, nitric oxide; SNS, sympathetic nervous system.
See this image and copyright information in PMC

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