Hypertension as a risk factor for ischemic stroke in women

Women have a high lifetime risk of stroke, and hypertension (HTN) is a major stroke risk factor. We conducted a literature review of studies evaluating blood pressure (BP) and ischemic stroke risk in women; 18 studies were identified. The stroke risk increases in a graded manner with BP levels above 115/75 mm Hg. A 10-mm Hg increase in systolic BP has been associated with a 38% increased stroke risk in women. Women with mild HTN have a higher stroke risk than in men. Increased BP variability also augments the ischemic stroke risk. Antihypertensive therapy has been associated with a significant reduction in stroke incidence. A 10-mm Hg decrease in systolic BP with antihypertensive treatment was associated with a stroke risk reduction of 31%, regardless of the type of antihypertensive agent used. A dose-response relationship has been shown between the magnitude of BP lowering and stroke risk reduction. Discontinuation of antihypertensive treatment may lead to a higher ischemic stroke risk in women than in men. Optimal BP thresholds and targets for women need to be evaluated. Hormone therapy (especially combined therapy) increases the stroke risk, mostly in older hypertensive women compared with younger and normotensive women. Hypertensive disorders of pregnancy also increase stroke risk. Age and ethnicity may modify the magnitude of the effect of HTN on ischemic stroke risk. Strategies tailored to women for the prevention and treatment of HTN are needed to prevent stroke.