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Sex-Specific Blood Pressure Thresholds in Middle-Aged Adults
Katie Williams1,2, Benjamin Grobman1,2, Fredrick Larbi Kwapong1
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.W., B.G., F.L.K., H.C., R.-A.N.T.-O., L.H.N., M.Z., S.P.J.).
Insights
This study found no significant sex differences in cardiovascular disease (CVD) risk or blood pressure (BP) distribution among middle-aged adults. The findings do not support the need for sex-specific hypertension thresholds.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Existing research suggests higher cardiovascular disease (CVD) risk in women at lower blood pressure (BP) thresholds, prompting discussion on sex-specific hypertension guidelines.
- However, the clinical significance of these observations requires further investigation in diverse populations.
Purpose of the Study:
- To investigate potential sex differences in blood pressure (BP) distribution, cardiovascular disease (CVD) risk, and risk factor burden.
- To evaluate whether current hypertension thresholds are appropriate for both male and female adults.
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) study, visit 1 (1987-1989).
- Compared BP distribution, 10-year CVD risk scores, absolute risk, and relative risk of CVD between sexes.
- Stratified analyses by hypertension treatment status in participants without prior CVD.
Main Results:
- The study included 13,418 participants (56% women), with 25% receiving hypertension treatment.
- No consistent differences were observed in BP distribution, CVD risk factors, absolute risk, or relative risk of CVD between male and female adults.
- Males exhibited higher average 10-year CVD risk scores irrespective of treatment status.
Conclusions:
- The findings do not support the implementation of sex-specific hypertension thresholds in this middle-aged population.
- Further research may be needed to explore potential sex differences in CVD risk across different age groups and ethnicities.
Background:
Higher relative risk for cardiovascular disease (CVD) events at lower blood pressure (BP) thresholds in female versus male adults suggest that hypertension thresholds should be sex-specific.
Methods:
We used the ARIC study (Atherosclerosis Risk in Communities) visit 1 (1987-1989) to compare the BP distribution, estimated risk (via the 10-year Predicting Risk of Cardiovascular Disease Events score), absolute risk, and relative risk of CVD according to BP thresholds, stratified by sex and hypertension treatment status, in participants without prior CVD.
Results:
Of 13 418 participants (56% women, mean age [54±5.7 years]), 25% were treated for hypertension. Males had higher average 10-year CVD risk scores regardless of treatment. The distribution of BP and prevalence of CVD risk factors was similar for male and female adults. Incidence rates (per 10 000 person-years) comparing a systolic BP threshold of ≥140 versus <140 mm Hg for coronary heart disease were 30.9 and 12.0 among untreated male and female adults (P=0.07) and 27.4 versus 16.5 among treated male and female adults (P=0.63). HRs comparing a systolic BP threshold of ≥140 versus <140 mm Hg for coronary heart disease were 1.49 and 1.72 among untreated male and female adults (P=0.16) and 1.30 versus 1.40 among treated male and female adults (P=0.93).
Conclusions:
In this middle-aged population, there were no consistent differences in BP distribution, risk factor burden, absolute risk, or relative risk of CVD between male and female adults. These findings do not support a sex-specific threshold for hypertension.
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