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Gender-specific differences in central blood pressure and optimal target blood pressure based on the prediction of
Min-Sik Kim1, Gee-Hee Kim1,2
1Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Insights
Central blood pressure (CBP) monitoring reveals that postmenopausal women face increased cardiovascular disease (CVD) risk at higher blood pressure (BP) levels. Maintaining optimal BP is crucial for this demographic to mitigate risks.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- Hypertension (HBP) affects both genders, with central blood pressure (CBP) offering a more accurate predictor of cardiovascular disease (CVD) outcomes than peripheral blood pressure (BP).
- Understanding gender-specific differences in CBP and optimal target BP is crucial for managing HBP and its complications, including CVD and heart failure (HF).
Purpose of the Study:
- To evaluate gender-specific differences in central blood pressure (CBP).
- To determine optimal target blood pressure (BP) levels for patients with hypertension (HBP), considering cardiovascular disease (CVD), heart failure (HF), and hypertensive complications.
- To investigate the impact of menopause on cardiovascular risk in relation to BP levels.
Main Methods:
- A cohort of 2,115 patients with HBP was enrolled between June 2011 and December 2015, with follow-up through December 2019.
- Central blood pressure (CBP) was measured using radial tonometry.
- A composite primary endpoint of CVD, HF, and hypertensive complications was analyzed using multivariable Cox proportional hazards models.
Main Results:
- No significant difference in the lowest blood pressure (BP) level was observed between men and women regarding cardiovascular disease (CVD) incidence.
- In postmenopausal women (78.1% of women), central blood pressure (CBP) and systolic BP increases of 10 mmHg correlated with 10-11% and 12-13% increased risk, respectively.
- Pulse pressure (PP) showed a 2% risk increase per 10 mmHg, but a notable 19% increase in postmenopausal women.
Conclusions:
- Postmenopausal women exhibit elevated cardiovascular disease (CVD) risk at blood pressure (BP) levels exceeding optimal targets.
- Cardiovascular risk in postmenopausal women is not elevated at BP values below the optimal threshold.
- Achieving and maintaining well-controlled blood pressure (BP) is paramount for reducing cardiovascular risk in postmenopausal women.
Background:
Hypertension (HBP) is a common disease among both men and women. Central blood pressure (CBP) is a method of evaluating aorta pressure that can assess the intrinsic BP of an individual patient that more closely correlates with cardiovascular disease (CVD) outcomes than peripheral BP parameters. We evaluated gender-specific differences in CBP and optimal target BP based on a composite outcome of CVD, heart failure (HF), and hypertensive complications in patients with HBP.
Method:
Patients were enrolled from June 2011 to December 2015 and were followed through December 2019. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.
Result:
The median follow-up period for enrolled patients was 6.5 years. Out of a total of 2,115 patients with an average age of 57.9 ± 13.6 years, 266 patients (12.6%) had events of primary end points during the follow-up period. There was no difference in the lowest BP level between men and women in the incidence of CVD. Among the women (49.6%), 78.1% were postmenopausal. In a multivariable Cox proportional hazards model, CBP and systolic BP showed an increase in risk of 10 and 11%, respectively, with every 10 mmHg increase, and there was a similar trend of 12 and 13%, respectively, in postmenopausal women. However, PP showed an increase in risk of about 2% every 10 mmHg increase, but a tendency to increase risk by 19% in postmenopausal women.
Conclusion:
This study demonstrated that postmenopausal women will continue to show increased risk for CVD at BP higher than the optimal level. Conversely, there was no increase in CV risk due to menopause at BP values below the optimal level. Therefore, well-controlled BP is more important in postmenopausal women.
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