Hypertension Mechanisms May Differ Between Men and Women

Carlos M Ferrario, MD, FAHA, FASH, FACC Dewitt-Cordelll Professor of Surgical Sciences Professor, Internal Medicine-Nephrology Professor, Physiology-Pharmacology Wake Forest University School of Medicine Winston-Salem, NC 27157-1032 Vice-President, Consortium Southeastern Hypertension Control Editor-in-Chief Therapeutic Advances in Cardiovascular Disease MedicalResearch.com Interview with:
Carlos M Ferrario, MD, FAHA, FASH, FACC
Dewitt-Cordelll Professor of Surgical Sciences
Professor, Internal Medicine-Nephrology
Professor, Physiology-Pharmacology
Wake Forest University School of Medicine
Winston-Salem, NC 27157-1032
Vice-President, Consortium Southeastern Hypertension Control
Editor-in-Chief, Therapeutic Advances in Cardiovascular Disease

MedicalResearch.com: What are the main findings of the study?

Dr. Ferrario: A significant and unexpected difference in the hemodynamic mechanisms that account for the elevated blood pressure between untreated hypertensive men and women.

The main findings were:

“Despite there being no differences between women and men in terms of office blood pressure, heart rate and body mass index, men demonstrated lower values of pulse pressure, systemic vascular resistance, brachial artery pulse wave velocity and augmentation index. In each of the three hypertension categories, the increased blood pressure in men was associated with significant augmentations in stroke volume and cardiac output compared with women. Sex-related hemodynamic differences were associated in women with higher plasma levels of leptin, hs-CRP, plasma angiotensin II and serum aldosterone. In women but not men, hs-CRP correlated with plasma concentrations of transforming growth factor β1 (TGFβ1) and body weight; in addition, plasma TGFβ1 correlated with levels of serum vascular cell adhesion molecule 1.”

MedicalResearch.com: Were any of the findings unexpected?

Dr. Ferrario: Definitely yes, since the accepted tenet is that the mechanisms by which blood pressure rises in hypertensive individuals is basically the same in men and women. Moreover, the greater degree of alterations in biomarkers of inflammatory and hormonal components of the disease in women were unexpected. These findings suggest a greater degree of vascular disease in women compared to men.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Ferrario: Our study shows that the degree of vascular disease is greater in hypertensive women compared to men. In addition, the finding of a higher degree of vascular stiffness and vasoconstriction in women should be used as a guide for use of antihypertensive agents that have significant vasodilator actions. In other words, antihypertensive treatment should be tailored on the basis of hemodynamic differences between the sexes. This is an important conclusion as to-date there are no specific recommendations of individualized therapy as a function of gender.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Ferrario: We need additional studies to confirm these findings and also explore whether these differences are present also in African Americans and Hispanic men and women.

We also need to reevaluate the comparative efficacy of current antihypertensive drugs as a function of gender. This is not a trivial matter as we dose these agents equally in men and women even though their body build and metabolism is different. Furthermore, we need to assess the impact of these findings in terms of whether they do reflect know differences in cardiovascular events between the sexes.

Citation:
Hemodynamic and hormonal patterns of untreated essential hypertension in men and women

Ther Adv Cardiovasc Dis. 2013 Dec;7(6):293-305. doi: 10.1177/1753944713513221. Epub 2013 Nov 26.

Ferrario CM, Jessup JA, Smith RD

 

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