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Hypertension poses health dangers for women

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Vascular disease higher in women with elevated blood pressure

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Knowledge of hemodynamic factors accounting for the development of hypertension should help to tailor therapeutic approaches and improve blood pressure control. Few data exist regarding sex differences of hemodynamic factors contributing to hypertension progression among patients with untreated nondiabetic stage I and II prehypertension as defined by the Joint National Committee-7 guidelines, according to researchers from Wake Forest University School of Medicine.

For the first time researchers found significant differences in the mechanisms that cause high blood pressure in women as compared to men.

According to Dr. Carlos M. Ferrario, MD, FACA, FACC, Laboratory of Translational Hypertension Research, Department of Surgery, Wake Forest University School of Medicine, and lead author of study, "The medical community thought that high blood pressure was the same for both sexes and treatment was based on that premise.

"This is the first study to consider sex as an element in the selection of antihypertensive agents or base the choice of a specific drug on the various factors accounting for the elevation in blood pressure.”

Even though there has been a significant decline in cardiovascular disease mortality in men during the last 20 to 30 years, the same has not held true for women. In fact, heart disease has become the leading cause of death in women in the United States, accounting for approximately a third of all deaths. So why the discrepancy if men and women have been treated in the same way for the same condition?, said Dr. Ferrario.

The apparent gender-related differences in the disease and the lack of understanding of the basic biological mechanisms involved prompted the research by the Wake Forest Baptist team.

Participants in this new comparative study included 61 men and 39 women, aged 53 years and older with untreated hypertension and no other major diseases.

In order to identify the hemodynamic and hormonal profile of participants researchers used an array of specialized tests; noninvasive impedance cardiography, applanation tonometry and plasma measures of angiotensin II, angiotensin (1–7), serum aldosterone, high-sensitivity C-reactive protein (hs-CRP) and cytokine biomarkers of inflammation,. These tests which can be performed in a physician’s office can indicate whether the heart or the blood vessels were primarily involved in elevating the blood pressure.

The results showed 30 to 40% more vascular disease in women than men. In addition, there were significant physiologic differences in the women's cardiovascular system, including types and levels of hormones involved in blood pressure regulation, that contribute to the severity and frequency of heart disease.

In their conclusion the researchers write” The impact of sex differences in the hemodynamic factors accounting for the elevation in arterial pressure in subjects with essential hypertension has been poorly characterized or this information is not available. We suggest that this gap in knowledge may adversely influence choices of drug treatment since our study shows for the first time significant differences in the hemodynamic and hormonal mechanisms accounting for the increased blood pressure in women compared to men.”

"This is the first study to consider sex as an element in the selection of antihypertensive agents or base the choice of a specific drug on the various factors accounting for the elevation in blood pressure, said Dr. Ferrario.

In closing he said "Our study findings suggest a need to better understand the female sex-specific underpinnings of the hypertensive processes to tailor optimal treatments for this vulnerable population.” We need to evaluate new protocols – what drugs, in what combination and in what dosage – to treat women with high blood pressure."

Co-authors for this study are Dr. Jewell Jessup, PhD, and Dr. Ronald Smith, MD, of Wake Forest Baptist Medical Center.

This new study is published in the December edition of Therapeutic Advances in Cardiovascular Disease

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