[Women and hypertension]

Arterial hypertension is a major risk factor for the high cardiovascular morbidity and mortality in Western industrialized countries. In Germany, more women than men suffer from hypertension and more women than men die of cardiovascular disease. It has been shown that, although the cardiovascular risk in premenopausal women is reduced compared to men, this is reversed after the onset of the menopause. Endogenous estrogens are thought to protect younger women from cardiovascular disease. Early hypertension trials did not include women, and initially it was thought that women would not profit from antihypertensive treatment. However, since then it has been shown that both women and men benefit from adequate blood pressure lowering. Treatment effects are greater for older than for younger women. Overall, more women than men are being treated for hypertension, and adherence to therapy is greater in women. Lifestyle changes as a means for curbing high blood pressure are less effective in women. As yet, only few data exist about gender-specific differences regarding the efficacy of the various antihypertensive drug classes and side effects. Electrolyte imbalance as a consequence of treatment with thiazide diuretics and cough as a sequel of ACE inhibitors are more frequent in women. The latest data collected in the Women's Health Initiative Observational Study, indicate an increased cardiovascular risk for women being treated with calcium channel blockers as monotherapy or in combination with diuretics. At present and independent of the sexes most hypertensive patients in Germany are not being treated adequately. Concerted efforts are needed to change this situation and further studies will have to show, whether gender-specific strategies should be employed.