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Treating hypertension in women: open-ended questions and therapeutic options
1Centro di Fisiologia Clinica e Ipertensione, Via F. Sforza 35, 20122 Milan, Italy. alberto.morganti@unimi.it
Insights
Treating hypertension in women, especially older women, is beneficial. Angiotensin II receptor antagonists show promise as a well-tolerated first-line treatment for hypertensive women.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Women's Health
Background:
- Early studies questioned the benefit of lowering blood pressure in women with mild hypertension.
- Recent trials demonstrate that hypertension treatment benefits women, particularly the elderly.
- Hypertensive women face higher cardiovascular disease risks due to prevalence and undertreatment.
Purpose of the Study:
- To review the current understanding of hypertension management in women.
- To evaluate the efficacy and tolerability of different antihypertensive drug classes in women.
- To identify optimal future therapeutic strategies for hypertension in women.
Main Methods:
- Literature review of early and recent clinical trials on hypertension in women.
- Analysis of comparative effectiveness and side effect profiles of various antihypertensive medications.
- Assessment of treatment guidelines and future therapeutic trends.
Main Results:
- Hypertension treatment is clearly beneficial for women, especially older women.
- Diuretics are common but their rationale is unclear; other classes have more side effects in women.
- Angiotensin II receptor antagonists are effective and well-tolerated.
Conclusions:
- Aggressive hypertension management is crucial for women at increased cardiovascular risk.
- Current treatment choices like diuretics lack clear rationale, and other agents have higher adverse event rates in women.
- Angiotensin II receptor antagonists represent a promising future first-line therapy for hypertension in women due to efficacy and tolerability.
Abstract:
Early intervention studies have challenged the notion that lowering blood pressure is beneficial in women with mild hypertension. In contrast, results of more recent trials have clearly shown that treatment of hypertension is of benefit in women, particularly in elderly women. Aggressive treatment of hypertension is advisable in this subset of the population that is exposed to a greater risk of hypertension-related cardiovascular diseases because of the greater prevalence of hypertension and of its inadequate treatment. Hypertensive women are preferentially treated with diuretics but the rationale for this therapeutic selection is unclear. Calcium antagonists, beta-blockers and angiotensin-converting enzyme inhibitors exert an antihypertensive action similar to that of diuretics, but their use is limited by the adverse effects that are more frequent in women than in men. Angiotensin II receptor antagonists, being effective in lowering blood pressure and particularly well tolerated, may represent, in the future, the first-line drugs for treating hypertension in women.