Sex differences in cardiovascular outcomes in patients with incident hypertension

The time of initial hypertension diagnosis represents an opportunity to assess subsequent risk of adverse cardiovascular outcomes. The extent to which women and men with newly identified hypertension are at a similar risk for adverse cardiovascular events, including chronic kidney disease (CKD), is not well known.

Among women and men with incident hypertension from 2001 to 2006 enrolled in the Cardiovascular Research Network (CVRN) Hypertension Registry, we compared incident events including all-cause death; hospitalization for myocardial infarction (MI), heart failure or stroke; and the development of CKD. Multivariable models were adjusted for patient demographic and clinical characteristics.

Among 177,521 patients with incident hypertension, 55% were women. Compared with men, women were older, more likely white and had more kidney disease at baseline. Over median 3.2 years (interquartile range 1.6-4.8) of follow-up, after adjustment, women were equally likely to be hospitalized for heart failure [hazard ratio 0.90, 95% confidence interval (CI) 0.76-1.07] and were significantly less likely to die of any cause (hazard ratio 0.85, 95% CI 0.80-0.90) or be hospitalized for MI (hazard ratio 0.44, 95% CI 0.39-0.50) or stroke (hazard ratio 0.68, 95% CI 0.60-0.77) compared with men. Women were significantly more likely to develop CKD (9.60 vs. 7.15%; adjusted hazard ratio 1.17, 95% CI 1.12-1.22) than men.

In this cohort with incident hypertension, women were more likely to develop CKD and less likely to develop other cardiovascular outcomes compared with men. Future studies should investigate the potential reasons for these sex differences.