Gender and age differences in antihypertensive drug use and blood pressure control

Öz

Aim: This study aimed to investigate the impact of gender on antihypertensive treatment patterns and blood pressure (BP) control in hypertensive patients. Material and Methods: This retrospective study included 918 hypertensive patients (mean age: 56.5 ± 12.3 years; 530 men, 388 women) under antihypertensive treatment, including diuretics, beta blockers, calcium channel blockers (CCB), angiotensin converting enzyme inhibitor (ACEI), and angiotensin receptor blockers (ARB). BP control was defined as systolic and diastolic BP being <140/90 mmHg during the 6-month follow-up. Antihypertensive medications and BP control were compared between genders, and subgroup analyses were performed based on age groups. Results: In the general population, BP control did not show a significant difference between genders. ACE inhibitors were prescribed more frequently to men (45.7% vs. 33.5%, p < 0.001), while women were more likely to receive monotherapy (24.2% vs. 19.6%, p < 0.05). Women showed better BP control with diuretics than men (46.6% vs. 34.1%, p = 0.037), and monotherapy was more effective in women than in men (38.3% vs. 23.1%, p = 0.020). Younger women (18–44 years) using calcium channel blockers (CCBs) demonstrated superior BP control compared to men in the same age group (41.2% vs. 31.3%, p = 0.042). Other antihypertensive drugs showed no significant gender- and age-related differences in their effect on BP control. Conclusion: Gender-based differences were observed in antihypertensive treatment patterns and BP control. Women showed better BP control with monotherapy and specific drug classes like diuretics and CCBs in younger populations. These findings highlight the importance of gender-specific strategies in hypertension management to optimize outcomes.

Anahtar Kelimeler

• Antihypertensive drugs
• blood pressure
• gender
• hypertension

Antihipertansif ilaç kullanımı ve kan basıncı kontrolünde cinsiyet ve yaş farklılıkları

Öz

Amaç: Bu çalışma, hipertansif hastalarda antihipertansif tedavi modelleri ve kan basıncı (KB) kontrolü üzerindeki cinsiyet etkisini araştırmayı amaçlamıştır. Gereç ve Yöntemler: Bu retrospektif çalışmaya, antihipertansif tedavi alan 918 hipertansif hasta (ortalama yaş: 56,5 ± 12,3 yıl; 530 erkek, 388 kadın) dahil edilmiştir. Tedavi, diüretikler, beta blokerler, kalsiyum kanal blokerleri (CCB), anjiyotensin dönüştürücü enzim inhibitörleri (ACEI) ve anjiyotensin reseptör blokerlerini (ARB) içerdi. Kan basıncı kontrolü, 6 aylık takip süresince sistolik ve diyastolik KB’nin <140/90 mmHg olması olarak tanımlandı. Antihipertansif ilaçlar ve kan basıncı kontrolü, cinsiyetler arasında karşılaştırılmış ve yaş gruplarına göre alt grup analizleri yapıldı. Bulgular: Genel popülasyonda, BP kontrolü cinsiyetler arasında anlamlı bir fark göstermedi. ACE inhibitörleri erkeklere daha sık reçete edilirken (%45,7'ye karşı %33,5, p < 0,001), kadınların monoterapi alma olasılığı daha yüksekti (%24,2'ye karşı %19,6, p < 0,05). Kadınlar diüretiklerle erkeklerden daha iyi BP kontrolü gösterdi (%46,6'ya karşı %34,1, p = 0,037) ve monoterapi kadınlarda erkeklerden daha etkiliydi (%38,3'e karşı %23,1, p = 0,020). Kalsiyum kanal blokerleri (KKB) kullanan daha genç kadınlar (18-44 yaş), aynı yaş grubundaki erkeklere kıyasla üstün BP kontrolü gösterdi (%41,2'ye karşı %31,3, p = 0,042). Diğer antihipertansif ilaçlar BP kontrolü üzerindeki etkilerinde anlamlı cinsiyet ve yaşla ilgili farklılıklar göstermedi. Sonuçlar: Antihipertansif tedavi modelleri ve KB kontrolü üzerinde cinsiyete dayalı farklılıklar gözlenmiştir. Kadınlar, monoterapi ve diüretikler veya genç yaş grubunda CCB gibi belirli ilaç sınıflarıyla daha iyi KB kontrolü sağlamıştır. Bu bulgular, hipertansiyon yönetiminde cinsiyete özgü stratejilerin benimsenmesinin sonuçları optimize etmek için önemini vurgulamaktadır.

Anahtar Kelimeler

• Antihipertansif ilaçlar
• cinsiyet
• hipertansiyon
• kan basıncı.

Kaynakça

1. Mills KT, Stefanescu A, and He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37.
2. Kivrak A and Yildirim A. Predictive Performance of Triglyceride-Glucose Index on Asymptomatic Multiple Organ Damage in Patients with Newly Diagnosed Hypertension. Rev Invest Clin. 2023;75(5):221-32.
3. Fuchs FD and Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 2020;75(2):285-92.
4. Guerrero-Garcia C and Rubio-Guerra AF. Combination therapy in the treatment of hypertension. Drugs Context. 2018;7:212531.
5. Arguedas JA, Leiva V, and Wright JM. Blood pressure targets in adults with hypertension. Cochrane Database Syst Rev. 2020;12(12):CD004349.
6. Daugherty SL, Masoudi FA, Ellis JL, et al. Age-dependent gender differences in hypertension management. J Hypertens. 2011;29(5):1005-11.
7. Osude N, Durazo-Arvizu R, Markossian T, et al. Age and sex disparities in hypertension control: The multi-ethnic study of atherosclerosis (MESA). Am J Prev Cardiol. 2021;8:100230.
8. Maas AH and Franke HR. Women's health in menopause with a focus on hypertension. Neth Heart J. 2009;17(2):68-72.

9. Lima R, Wofford M, and Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep. 2012;14(3):254-60.
10. Taddei S. Blood pressure through aging and menopause. Climacteric. 2009;12 Suppl 1:36-40.
11. Pitha J, Vaneckova I, and Zicha J. Hypertension after the Menopause: What Can We Learn from Experimental Studies? Physiol Res. 2023;72(Suppl 2):S91-S112.
12. Leuzzi C and Modena MG. Hypertension in postmenopausal women: pathophysiology and treatment. High Blood Press Cardiovasc Prev. 2011;18(1):13-8.
13. Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, and Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open. 2020;10(7):e036418.
14. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324.
15. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018.
16. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104.
17. Al Kibria GM, Nemirovsky A, Sharmeen A, and Day B. Age-stratified prevalence, treatment status, and associated factors of hypertension among US adults following application of the 2017 ACC/AHA guideline. Hypertens Res. 2019;42(10):1631-43.
18. Sabbatini AR and Kararigas G. Estrogen-related mechanisms in sex differences of hypertension and target organ damage. Biol Sex Differ. 2020;11(1):31.
19. Li N, Ma R, Wang S, et al. The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women. Clin Interv Aging. 2019;14:743-52.
20. Yangin HB, Kukulu K, and Sozer GA. The perception of menopause among Turkish women. J Women Aging. 2010;22(4):290-305.
21. Ceylan B and Ozerdogan N. Menopausal symptoms and quality of life in Turkish women in the climacteric period. Climacteric. 2014;17(6):705-12.
22. Reslan OM and Khalil RA. Vascular effects of estrogenic menopausal hormone therapy. Rev Recent Clin Trials. 2012;7(1):47-70.
23. Raj A, Chakole S, Agrawal S, et al. The Impact of Menopause on Cardiovascular Aging: A Comprehensive Review of Androgen Influences. Cureus. 2023;15(8):e43569.
24. Chen SC, Lo TC, Chang JH, and Kuo HW. Variations in aging, gender, menopause, and obesity and their effects on hypertension in taiwan. Int J Hypertens. 2014;2014:515297.
25. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, and Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008;52(5):818-27.
26. Bhagavathula AS, Shah SM, and Aburawi EH. Medication Adherence and Treatment-Resistant Hypertension in Newly Treated Hypertensive Patients in the United Arab Emirates. J Clin Med. 2021;10(21)
27. Shehab A, Bhagavathula AS, and AlHajri N. Sex differences in the antihypertensive treatment and risk of uncontrolled hypertension in 5308 hypertensive patients in the United Arab Emirates. Blood Press Monit. 2021;26(5):333-40.
28. Gu Q, Burt VL, Paulose-Ram R, and Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21(7):789-98.
29. Wang J, Jiang W, Sharma M, et al. Sex differences in antihypertensive drug use and blood pressure control. Postgrad Med J. 2019;95(1124):295-99.
30. Morales-Olivas FJ. Diuretics use in the management of hypertension. Hipertens Riesgo Vasc. 2024;41(3):186-93.
31. Turnbull F, Woodward M, Neal B, et al. Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. Eur Heart J. 2008;29(21):2669-80.
32. Mackay FJ, Pearce GL, and Mann RD. Cough and angiotensin II receptor antagonists: cause or confounding? Br J Clin Pharmacol. 1999;47(1):111-4.
33. Os I, Bratland B, Dahlöf B, Gisholt K, Syvertsen JO, and Tretli S. Female preponderance for lisinopril-induced cough in hypertension. American journal of hypertension. 1994;7(11):1012-15.
34. Laven SA, Meijs DA, Mohseni-Alsalhi Z, et al. Sex Differences in the Efficacy of Angiotensin Receptor Blockers in Blood Pressure Lowering and Cardiac Remodeling: A Systematic Review and Meta-Analysis. Medical Research Archives. 2023;11(10)
35. Wang L, Wang X, Qu HY, et al. Role of Kidneys in Sex Differences in Angiotensin II-Induced Hypertension. Hypertension. 2017;70(6):1219-27.