Women typically have lower systolic blood pressure levels than men in the 30- to 44 year age groups. However, systolic blood pressure rises more steeply with age in females than in males which means that at or beyond 60 years of age, women have a higher blood pressure and greater prevalence of hypertension. The continuous relationship between blood pressure and cardiovascular disease is similar in females and males, except for the lower absolute incidence of coronary disease in females before old age.
In a meta-analysis of individual patients, the beneficial effect of antihypertensive treatment versus placebo was found to be similar in the two genders. No gender-based meta-analysis has yet been made of trials comparing different active treatments but most studies have shown similar risk reductions by the various regimens in either gender group, with the exception of the ANBP 2 trial,1 which reported the benefit of enalapril- over the hydrochlorothiazide-based treatment to be limited to males, and the VALUE trial,2 which reported amlodipine to be more effective than valsartan in lowering blood pressure and reducing cardiac events in women but not in men.
A most important recommendation about antihypertensive treatment in women is avoidance of potentially teratogenic drugs in the child bearing age. Among current antihypertensive agents, ACE inhibitors and angiotensin receptor antagonists should be avoided in fertile women, or immediately withdrawn in case of pregnancy.3
References
1. Wing LM, Reid CM, Ryan P, Beilin LJ, Brown MA, Jennings GL, Johnston CI, McNeil JJ, Macdonald GJ, Marley JE, Morgan TO, West MJ, Second Australian National Blood Pressure Study Group. A comparison of outcomes with angiotensin-converting–enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003; 348:583–592.
2. Zanchetti A, Julius S, Kjeldsen S, McInnes GT, Hua T, Weber M, Laragh JH, Plat F, Battegay E, Calvo-Vargas C, Cieslinski A, Degaute JP, Holwerda NJ, Kobalava J, Pedersen OL, Rudyatmoko FP, Siamopoulos KC, Storset O. Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial. J Hypertens 2006; 24:2163–2168.
3. 2007 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).Journal of Hypertension 2007, 25:1105–1187
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