Primary (essential) hypertension in women
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Pamela S Douglas, MD
Pamela S Douglas, MD
- Ursula Geller Professor of Research in Cardiovascular Diseases
- Duke University Medical Center
Primary hypertension (formerly called "essential" hypertension) is a common problem in women as it is in men. The pathogenesis and clinical implications of primary hypertension in women are generally similar to those in men, but there are some differences.
Before age 50 years, women have a lower prevalence of hypertension than men, but after age 55 years, they have a higher prevalence . The eventual prevalence of hypertension in women is similar to that in men, averaging 30 to 40 percent in blacks and roughly 20 percent in whites. The prevalence rises with age, approaching 80 to 90 percent in women over the age of 70 years if subjects with isolated systolic hypertension are included (figure 1) [1,2]. (See "The prevalence and control of hypertension".)
There are, however, several important gender-related differences:
●The incidence of hypertensive complications is significantly lower in women than in men, particularly in premenopausal women [3,4]. The decrease in risk is primarily due to a reduced incidence of coronary heart disease (which is only one-half that in men at the same blood pressure), while the difference in the risk of stroke is much less prominent . Left ventricular hypertrophy (LVH) is less common in women than in men with similar degrees of hypertension .
●A greater blood pressure load seems to be required to produce cardiovascular injury in women. This difference is taken into account in a report from New Zealand that recommends that therapy be given only to those patients with an estimated overall 10-year risk for cardiovascular complications of at least 20 percent . At equal degrees of hypertension, women were at lower risk than men in all age groups from 40 to 70 years (figure 2).
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