Sex differences in the renin-angiotensin-aldosterone system and its roles in hypertension, cardiovascular, and kidney

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Sarah M Nwia1,2, Ana Paula O Leite3, Xiao Chun Li1,2

  • 1Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, United States.

Frontiers in Cardiovascular Medicine
|July 5, 2023
PubMed

Insights

This review explores sex differences in hypertension, focusing on the renin-angiotensin system. Understanding these biological distinctions is key to developing tailored treatments for cardiovascular disease and improving patient outcomes.

Area of Science:

  • Cardiovascular physiology
  • Endocrinology
  • Hypertension research

Background:

  • Cardiovascular disease (CVD) exhibits significant biological sex differences, impacting prevention and treatment strategies.
  • Hypertension (high blood pressure) is a primary risk factor for CVD, stroke, and renal failure, affecting nearly half of American adults.
  • While women have lower hypertension rates during reproductive years, this protection diminishes post-menopause, and treatment-resistant cases highlight unclear underlying mechanisms.

Purpose of the Study:

  • To review recent advances in understanding sex-specific physiological mechanisms influencing the renin-angiotensin system and blood pressure control.
  • To discuss the role of genetic and hormonal differences in hypertension development.
  • To examine sex disparities in hypertension management, treatment efficacy, and patient outcomes.

Main Methods:

  • Literature review of recent research on sex differences in cardiovascular physiology.
  • Analysis of studies investigating the renin-angiotensin system in relation to sex hormones and blood pressure.
  • Synthesis of epidemiological data and clinical trial findings on hypertension in men and women.

Main Results:

  • Biological sex significantly influences cardiovascular disease pathology, including hypertension.
  • The renin-angiotensin system's function and its role in blood pressure regulation show distinct sex-based variations.
  • Menopause is a critical transition where women's hypertension risk approaches that of men.

Conclusions:

  • Tailoring hypertension prevention and treatment based on biological sex is crucial for improving patient outcomes.
  • Further research into sex-specific genetic and hormonal mechanisms is needed to address treatment-resistant hypertension.
  • Understanding sex differences in the renin-angiotensin system can lead to more effective, personalized therapeutic strategies.

Keywords:
cardiovascularhypertensionkidneyrenin-Angiotensin systemsex differences

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