Early in Life Hypertension for Women May Signal Heart Disease Later in Life

(©DraganaGordic, AdobeStock,219411641)

Blood pressure irregularities start early for women and progress more rapidly than in men, eventually leading to cardiovascular disease later in life, researchers report in JAMA Cardiology.

It was once thought that women and men are susceptible to the same types of cardiovascular disease. Now, new studies have shown that women are more likely to develop coronary microvascular dysfunction (CMD) and heart failure with preserved ejection fraction (HFpEF), especially when combined with hypertension.

In this study, which was led by Susan Cheng, M.D., MPH, Cedars-Sinai Medical Center, Los Angeles, researchers set out to determine how cardiovascular function in women and men early in life, manifest later in life.

Dr. Cheng and colleagues analyzed 144,599 blood pressure measures from 32,833 patients (54% female) that were collected over 43 years (1971-2014) from four U.S.-based studies.  

The findings show that despite previous beliefs about sex differences for CVD onset, women do not lag behind men 10-20 years. "Blood pressure measures actually progress more radily in women than in men, beginning early in life," researchers wrote.

They found that women had a steeper increase in blood pressure that began as early as their 30s and continued from there. "After adjustment for multiple cardiovascular disease risk factors, these between-sex differences in all blood pressure trajectories persisted," the authors wrote.

They found that blood pressure measures progress more rapdily in women than men beginning early in life. "This early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men," the authors wrote.

In an editorial that accompanied the study, Nanette K. Wenger, M.D., Emory Women's Heart Center, Georgia, discussed the importance of access to care for women.

"We must remember that the cardiovascular health of women involves more than sex-specific medical research. The emerging science will be useful only when women have equal access to high-quality, affordable health care. Women’s equity thus involves equity in research and prevention and equal access to care and treatments," she said.

Dr. Wenger outlined how CVD presents differently in women:

• Hypertension is associated with more left ventricular hypertrophy and less hypertrophy regression in women with hypertension than men.

• Abdominal obesity is associated with left ventricular mass more in women than in men.

• During antihypertensive treatment, women are more likely to develop left ventricular hypertrophy than men, with the risk of incident left ventricular hypertrophy further increased by the presence of obesity.

• The presence of left ventricular hypertrophy in women offsets their beneficial sex difference in cardiovascular risk.

• An enlarged left atrium is more prevalent in women with hypertension than men with hypertension being a common etiology of atrial fibrillation.

• In the Tromso Study, systolic blood pressure was a stronger risk factor for myocardial infarction in women in contrast to total cholesterol as a stronger risk factor for myocardial infarction in men.

• Hypertensive heart disease is more prevalent in women than in men, less modifiable during antihypertensive treatment, and offsets women’s lower cardiovascular risk. Obesity, arterial stiffness, and inflammation are important modulators.

REFERENCES

Hongwei Ji, MD; Andy Kim, BA; Joseph E. Ebinger, MD; et al. "Sex Differences in Blood Pressure Trajectories Over the Life Course,"JAMA Cardiology. Jan. 15, 2019.

Nanette K. Wenger, MD, MACC, MACP. "Adverse Cardiovascular Outcomes for Women-Biology, Bias, or Both?," JAMA Cardiology, Jan. 15, 2020. doi:10.1001/jamacardio.2019.5576