Gender Difference of Blood Pressure Control Rate and Clinical Prognosis in Patients With Resistant Hypertension: Real-World Observation Study

Abstract

Background: There are several differences in the clinical course of hypertension due to the biological and social differences between men and women. Resistant hypertension is an advanced disease state, and significant gender difference could be expected, but much has not been revealed yet. The purpose of this study was to compare gender differences on the current status of blood pressure (BP) control and clinical prognosis in patients with resistant hypertension.

Methods: This is a multicenter, retrospective cohort study using common data model databases of 3 tertiary hospitals in Korea. Total 4,926 patients with resistant hypertension were selected from January 2017 to December 2018. Occurrence of dialysis, heart failure (HF) hospitalization, myocardial infarction, stroke, dementia or all-cause mortality was followed up for 3 years.

Results: Male patients with resistant hypertension were younger but had a higher cardiovascular risk than female patients. Prevalence of left ventricular hypertrophy and proteinuria was higher in men than in women. On-treatment diastolic BP was lower in women than in men and target BP achievement rate was higher in women than in men. During 3 years, the incidence of dialysis and myocardial infarction was higher in men, and the incidence of stroke and dementia was higher in women. After adjustment, male sex was an independent risk factor for HF hospitalization, myocardial infarction, and all-cause death.

Conclusion: In resistant hypertension, men were younger than women, but end-organ damage was more common and the risk of cardiovascular event was higher. More intensive cardiovascular prevention strategies may be required in male patients with resistant hypertension.

Keywords: Death; Heart Failure; Hypertension Resistant to Conventional Therapy; Myocardial Infarction; Sex Factors.

Fig. 1. Flow diagram.

SBP = systolic blood pressure, DBP = diastolic blood pressure.

Fig. 2. On-treatment BPs and its control rate during the follow-up period. (A) On-treatment BP during the follow-up period. (B) Target BP achievement rate during the follow-up period.

BP = blood pressure. ^*Age-adjusted P value < 0.05.

Fig. 3. Kaplan-Meier curves for clinical outcomes. (A) Dialysis; (B) Myocardial infarction; (C) Stroke; (D) Dementia; (E) All-cause death; (F) Net adverse event according to gender.