Sex differences in blood pressure and hypertension through adulthood

Sex differences in hypertension epidemiology and management are increasingly recognized, yet their variation across the adult life course remains incompletely understood. We examined sex-specific differences in hypertension prevalence, awareness, treatment, and blood pressure (BP) control in a German population.

This cross-sectional analysis included 10 000 participants (51% women; mean age 62 ± 8.5 years) from the Hamburg City Health Study. Hypertension was defined per 2023 European Society of Hypertension guidelines. Awareness, treatment, and BP control were defined based on self-reported diagnosis, current medication use, and treated BP below both thresholds. Age-stratified analyses (45-54, 55-64, and 65-74 years) allowed direct sex comparisons. Differences were assessed using modified Poisson regression adjusted for sociodemographic, comorbidity, and lifestyle factors.

Hypertension prevalence was higher in men than women (71% vs. 57%), particularly at 45-54 years [50% vs. 32%; adjusted prevalence ratio (PR) 1.44, 95% confidence interval (CI) 1.27-1.62]. Sex differences progressively attenuated with age (PR 1.23, 95% CI 1.15-1.32 at 55-64 years) and converged at 65-74 years (PR 1.04, 95% CI 0.99-1.08). Findings were consistent in analyses based on self-reported menopausal status. Awareness and treatment were similar between sexes. BP control remained low (∼40%) and declined in women at 65-74 years.

Hypertension prevalence was high and BP control suboptimal. Sex differences in hypertension prevalence varied across the adult life course, with higher prevalence among men at younger ages and convergence after age 55, coinciding with menopausal age. These findings support sex-specific, life stage-oriented hypertension screening and management strategies.