Hypertension Increases CVD Risk for Certain Women

Stage 1 hypertension is a stronger risk factor for adverse cardiovascular events in women during midlife than men, according to the results of a recent study.

The researchers utilized data from the Hordaland Health Study to evaluate the relationship between hypertension, sex, and acute coronary syndromes (ACS) such as myocardial infarction and unstable angina pectoris. Included in this study were 12,597 participants who had complete baseline measurements from their early 40s, as part of the first Hordaland Health Study survey in 1992-1993.

At baseline, 25% of women had stage 1 hypertension and 14% had stage 2 hypertension, compared to 35% and 31% of men. Over the 16-year follow-up period, 1.4% (n = 89) of women and 5.7% (n = 341) of men were hospitalized or died from ACS.

Overall, stage 1 hypertension was a stronger risk factor for ACS in women than in men. When compared to normotensive women, women with stage 1 hypertension had 2 times the risk of ACS, and women with stage 2 hypertension had 3 times the risk. This result comes after adjustment for confounding factors, including diabetes, smoking, body mass index, cholesterol, and physical activity. The association between hypertension stage and risk of ACS was not significant in men.

In both men and women, the risk of ACS increased with increasing systolic and diastolic blood pressure (BP) categories. However, a significant sex-interaction was observed for diastolic BP and the risk of ACS in women. There was no observed sex-interactions for systolic BP and the risk of ACS.

“In the Hordaland Health Study, BP 130-139/80-89 mmHg (stage 1 hypertension by American guidelines) in the early 40s doubled the risk of ACS during midlife in women, while the association was non-significant in men when adjusted for confounding CV risk factors. Stage 1diastolic BP was a stronger indicator of ACS risk than stage 1 systolic BP,” the researchers concluded. “Our results may contribute to explain why ACS incidence rates have declined less in young and middle-aged women than in their male counterparts.”

—Leigh Precopio

Reference:

Kringeland E, Tell GS, Midtbø H, Ingland J, Haugsgjerd TR, Gerdts E. Stage 1 hypertension, sex, and acute coronary syndromes during midlife: the Hordaland Health Study. Eur J Prev Cardiol. Published online May 16, 2021. doi: 10.1093/eurjpc/zwab068