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).
- Igho Pemu P, Ofili E. Hypertension in women: part I. J Clin Hypertens (Greenwich) 2008; 10:406.
- Franklin SS, Wong ND. Cardiovascular risk evaluation: an inexact science. J Hypertens 2002; 20:2127.
- Gueyffier F, Boutitie F, Boissel JP, et al. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Ann Intern Med 1997; 126:761.
- August P, Oparil S. Hypertension in women. J Clin Endocrinol Metab 1999; 84:1862.
- Gosse P, Ben Bouazza S, Lassere R, et al. Is high blood pressure different in males and females? J Hypertens (abstract) 2002; 20:A1.
- Jackson R, Barham P, Bills J, et al. Management of raised blood pressure in New Zealand: a discussion document. BMJ 1993; 307:107.
- Messerli FH, Garavaglia GE, Schmieder RE, et al. Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med 1987; 107:158.
- Hayes SN, Taler SJ. Hypertension in women: current understanding of gender differences. Mayo Clin Proc 1998; 73:157.
- Safar ME, Smulyan H. Hypertension in women. Am J Hypertens 2004; 17:82.
- Christou DD, Jones PP, Jordan J, et al. Women have lower tonic autonomic support of arterial blood pressure and less effective baroreflex buffering than men. Circulation 2005; 111:494.
- Garovic VD, Bailey KR, Boerwinkle E, et al. Hypertension in pregnancy as a risk factor for cardiovascular disease later in life. J Hypertens 2010; 28:826.
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401.
- Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265:3255.
- Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342:145.
- ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288:2981.
- Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014; 32:3.
- Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31:1281.
- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507.