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Published on: May 3, 2018
Sex Differences in Blood Pressure and Potential Implications for Cardiovascular Risk Management
Dean S Picone1, Elif Stoneman1, Antoine Cremer2
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., E.S., M.G.S., P.O., J.A.B., N.D.).
Insights
Accurate blood pressure (BP) measurement is crucial. Invasive aortic systolic BP is higher in women than men, suggesting women may face higher BP-related cardiovascular risk than cuff BP indicates.
Area of Science:
- Cardiovascular medicine
- Hypertension research
- Sex differences in health
Background:
- Accurate blood pressure (BP) measurement is vital for managing cardiovascular risk.
- While age-related BP trajectories differ between sexes, the agreement between cuff BP and invasive aortic BP is not well understood.
- This study investigated sex-specific differences in cuff BP versus invasive aortic BP.
Purpose of the Study:
- To determine sex differences between cuff-measured BP and invasive aortic BP.
- To analyze the discrepancies between these two BP measurement methods across different age groups.
- To assess the implications for cardiovascular risk assessment in women.
Main Methods:
- Utilized data from the Invasive Blood Pressure Consortium Database, including 1615 subjects undergoing coronary angiography.
- Measured upper-arm cuff BP and invasive aortic BP using 22 different cuff devices across 28 studies.
- Analyzed BP data stratified by sex and age.
Main Results:
- For identical cuff systolic BP (SBP) readings, invasive aortic SBP was 4.4 mm Hg higher in women than men.
- Sex differences in SBP were more pronounced with invasive aortic measurements and increased with age.
- Cuff BP underestimated invasive aortic pulse pressure significantly in older adults of both sexes.
Conclusions:
- Invasive aortic SBP is higher in women compared to men at equivalent cuff SBP readings.
- Current cuff BP measurements may underestimate the true BP-related cardiovascular risk in women.
- Further research is needed to determine how these findings impact cardiovascular risk prediction models.
Background:
Accurate blood pressure (BP) measurement is critical for optimal cardiovascular risk management. Age-related trajectories for cuff-measured BP accelerate faster in women compared with men, but whether cuff BP represents the intraarterial (invasive) aortic BP is unknown. This study aimed to determine the sex differences between cuff BP, invasive aortic BP, and the difference between the 2 measurements.
Methods:
Upper-arm cuff BP and invasive aortic BP were measured during coronary angiography in 1615 subjects from the Invasive Blood Pressure Consortium Database. This analysis comprised 22 different cuff BP devices from 28 studies.
Results:
Subjects were 64±11 years (range 40-89) and 32% women. For the same cuff systolic BP (SBP), invasive aortic SBP was 4.4 mm Hg higher in women compared with men. Cuff and invasive aortic SBP were higher in women compared with men, but the sex difference was more pronounced from invasive aortic SBP, was the lowest in younger ages, and the highest in older ages. Cuff diastolic blood pressure overestimated invasive diastolic blood pressure in both sexes. For cuff and invasive diastolic blood pressure separately, there were sex*age interactions in which diastolic blood pressure was higher in younger men and lower in older men, compared with women. Cuff pulse pressure underestimated invasive aortic pulse pressure in excess of 10 mm Hg for both sexes in older age.
Conclusions:
For the same cuff SBP, invasive aortic SBP was higher in women compared with men. How this translates to cardiovascular risk prediction needs to be determined, but women may be at higher BP-related risk than estimated by cuff measurements.
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