Hypertension: Are Current Guidelines Inclusive of Sex and Gender?

Area of Science:

• Cardiology
• Sex and Gender in Medicine

Background:

• Hypertension (HTN) is a leading cause of death for American women, necessitating evidence-based management guidelines.
• Existing sex- and gender-based differences in HTN epidemiology and management highlight a need for specialized guidance.
• Major medical societies aim to provide comprehensive HTN recommendations, but may overlook sex and gender considerations.

Approach:

• Reviewed four major hypertension guidelines: ACC, ACEP, ESC, and JNC8.
• Quantified sex- and gender-based medicine (SGBM) content by word count.
• Assessed the gender diversity of guideline authors.

Key Points:

• Only two of the four reviewed guidelines (ACC, ESC) included SGBM content, with significant variation in depth and scope.
• Pregnancy was the most covered topic within SGBM sections, yet still represented a small percentage of overall content.
• No significant correlation was found between the number of female authors and the extent of SGBM content.

Conclusions:

• Current hypertension management guidelines offer insufficient guidance on sex- and gender-based differences.
• Future research and guideline development must incorporate factors like gender identity, hormone therapy, pregnancy, lactation, menopause, and advanced age.
• Diverse guideline committees, including cisgender and transgender individuals from various backgrounds, are crucial for comprehensive recommendations.