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Sex Differences in Blood Pressure and Cardiovascular Disease in the UK Biobank: A Prospective Cohort Study

Rebecca K Kelly1,2, Katie Harris1, Cheryl Carcel1,3

  • 1The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

American Journal of Hypertension
|November 5, 2025
PubMed

Insights

Cardiovascular disease (CVD) risk is lowest at a slightly lower systolic blood pressure (SBP) for women than men. Despite higher relative risks in women at elevated SBP, absolute risks remain lower, not supporting sex-specific hypertension thresholds.

Area of Science:

  • Cardiology
  • Epidemiology
  • Public Health

Background:

  • Growing evidence suggests differing cardiovascular disease (CVD) risk associated with systolic blood pressure (SBP) between sexes.
  • This has prompted discussions on the necessity of sex-specific SBP thresholds for hypertension diagnosis.

Purpose of the Study:

  • To investigate sex-specific differences in the association between SBP and incident atherosclerotic CVD.
  • To evaluate the validity of sex-based SBP thresholds for CVD risk assessment.

Main Methods:

  • Prospective study of 420,649 UK Biobank participants without prior CVD.
  • Analysis of age-adjusted, sex-specific risks, relative risks (RRs), and risk differences (RDs) using Poisson and Cox regression models.

Main Results:

  • Over 13.6 years, 28,628 CVD events occurred, with risks showing a J-shape across BP levels, consistently higher in men.
  • Lowest CVD risk observed at SBP 100-<105 mmHg for women and 110-<115 mmHg for men.
  • While relative risks increased more steeply in women at SBP >120 mmHg, absolute risks and risk differences remained higher in men across all SBP levels.

Conclusions:

  • CVD risk is lowest at a slightly lower SBP in women, with a steeper RR increase at higher SBP.
  • However, absolute CVD risks and risk differences are consistently lower in women than men.
  • Current evidence does not support the implementation of lower SBP thresholds for diagnosing hypertension in women.
Abstract

Keywords:
blood pressurecoronary heart diseasehypertensionsex differencesstroke

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