Population-Based Cohort Study Shows Blood Pressure Trajectories Over The Life Course Progress More Rapidly in Women Compared to Men

Sahar Memar Montazerin, MD
By Sahar Memar Montazerin, MD on

A new study by Dr. Hongwei, published in JAMA Cardiology, demonstrated that blood pressure (BP) trajectories over the life course progress more rapidly in women compared to men, a process that begins as early as the third decade of life. This concept is inconsistent with the previously accepted notion that important vascular disease processes in women occur by 10 to 20 years delay compared to men. These sex-based differences in physiology may establish the cornerstone for future cardiovascular disorders that often present differently in women compared with men.

Over the last 2 decades, multiple reports have highlighted differences between women and men in the manifestation of cardiovascular disorders (CVDs), often referred to as delayed onset and atypical presentation in women. In addition, there is increasing evidence that the female gender is more prone than the male gender to develop coronary microvascular dysfunction, particularly in the presence of vascular risk factors such as hypertension. These data may provide evidence to consider the possibility that cardiovascular pathophysiology is fundamentally different between the sexes.

In a population-based, multi-cohort study, a total of 32,833 unique participants [17,733 women (54%)] were included. Data were extracted from large United States cohorts including the Framingham Heart Study (FHS) offspring cohort, the Atherosclerosis Risk in Communities (ARIC) Study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, and the Multi-Ethnic Study of Atherosclerosis (MESA). Multilevel longitudinal models were applied to demonstrate gender-specific BP trajectories over the age span and during a 43-year period (1971 – 2014) follow-up. New-onset hard CVD incidence was also recorded to further understand the gender-based BP trajectories in the context and as expected, a higher incidence was observed in men than in women.

According to this study, women compared with men tend to have a steeper increase in the BP elevation curve with aging, a trend beginning in the third decade of life and continuing afterward. These between-sex differences in BP curve over the timescale of age remained the same, however, attenuated after adjustment for multiple CVD risk factors (likelihood ratio test χ2 = 314 for systolic BP; χ2 = 31 for diastolic BP; χ2 = 129 for Mean arterial pressure; and χ2 = 485 for pulse pressure; P value for all < 0.001). Consistent with these data, another large scale study done in the United Kingdom showed a steeper increase in systolic blood pressure with aging in women compared to men. This difference in BP elevation between the genders may be explained by multiple factors including differences in hormones, chromosomal and non-chromosomal sex-based gene expressions as well as complex social, environmental, and economic elements. Another possible cause could be the observed smaller vessel caliber and smaller organs, even after adjusting for body surface area in women compared to men that predispose the female gender to the faster increase in mean arterial pressure with aging.

Given the result of this study, we can conclude, in contrast to the previous notion declaring CVD in women lags behind men by 10 to 20 years, vascular changes occur earlier and develop faster in women than in men. In fact, these gender-based physiologic differences may set the stage for the development of cardiovascular disorders that present differently in women compared to men. Additional research is needed to understand the gender-based variations in cardiovascular disorders and to optimize preventive and therapeutic care in both women and men.

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