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Sex-Specific Effects of Blood Pressure Lowering Pharmacotherapy for the Prevention of Cardiovascular Disease: An

Zeinab Bidel1,2,3, Milad Nazarzadeh1,2, Dexter Canoy1,2,3

  • 1Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom.

Hypertension (Dallas, Tex. : 1979)
|July 24, 2023
PubMed

Insights

Blood pressure lowering treatment benefits cardiovascular outcomes equally in men and women. This large meta-analysis found no sex-based differences in treatment effects across various blood pressure and age groups.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Epidemiology

Background:

  • Uncertainty exists regarding sex-specific effects of blood pressure (BP)-lowering treatments on cardiovascular outcomes, especially when BP is not severely elevated.
  • Investigating potential sex differences in treatment efficacy is crucial for personalized cardiovascular disease prevention.

Approach:

  • Conducted an individual participant-level data meta-analysis of 51 randomized controlled trials involving 358,636 participants (42% women).
  • Analyzed data using fixed-effect one-stage meta-analyses and Cox proportional hazard models, stratified by trial.
  • Categorized participants by sex, systolic BP (increments of 10 mm Hg), and age (categories from <55 to ≥85 years).

Key Points:

  • A 5-mm Hg systolic BP reduction decreased major cardiovascular event risk in both women and men (HR: 0.92 [0.89-0.95] for women, 0.90 [0.88-0.93] for men).
  • No significant heterogeneity of relative treatment effects by sex was observed for major cardiovascular disease or its components.
  • Treatment effects were consistent across different baseline BP and age categories, and across various antihypertensive medication classes for both sexes.

Conclusions:

  • Blood pressure reduction demonstrates similar efficacy in lowering cardiovascular risk for both women and men.
  • No evidence supports sex-based differences in the effectiveness of pharmacological blood pressure-lowering treatments.
  • Findings suggest a unified approach to blood pressure management regardless of sex across diverse patient populations.
Abstract

Keywords:
blood pressurecardiovascular diseaseshypertensionmeta-analysissex

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