Women Face Challenges In Controlling Hypertension 

Some Need More Medications Than Men

Researchers report that women have a greater burden of hypertension than their male counterparts and they receive more aggressive treatment for it, yet they obtain no better blood pressure control.

In addition, the researchers say that the impact of hypertension on mortality or recurrent cardiac events was similar between men and women.

Reporting their findings at the annual scientific session of the American Heart Association, the Duke University scientists say there are great opportunities to improve medical therapy and outcomes in women.

Cardiologist Kristin Newby, of the Duke Clinical Research Institute, wanted to know how the prevalence and treatment of hypertension varied between the sexes in patients who came to the hospital with an acute coronary syndrome (ACS). ACS occurs when a patient arrives at the hospital with chest pain and physicians must determine whether or not the symptoms are due to unstable angina or signal a real heart attack.

"Hypertension has been proven to be an independent risk factor for death or further cardiac events after ACS," Dr. Newby explains. "There is little doubt that hypertensive women with ACS are at a higher unadjusted risk for death or heart attack, but when you statistically adjust for such factors as age, kidney function, diabetes, or other heart problems, the risks turn out to be about the same.

"The difference in outcomes does not appear to be due totally to gender, but at least in part to these and other factors," Dr. Newby says.

Dr. Franz Messerli of the Ochsner Clinic Foundation Hospital in New Orleans, says, "It's harder for women to get to the goals [normal blood pressure readings], but despite that, women do remarkably well."

An encouraging finding, Dr. Messerli says, is that even though women received intense antihypertensive therapy and were not as well-controlled as men, "their outcomes are about the same."

Researchers Look at Data from Earlier Studies

To conduct the study, Dr. Newby consulted data gathered from two related international trials - SYMPHONY and 2nd SYMPHONY (Sibrafabin vs. aspirin to yield maximum protection from ischemic heart events post-acute coronary syndromes).

While these trials were designed to compare the effectiveness of aspirin to a new class of drugs that dissolves blood clots, researchers at the 931 participating centers also collected data on each patient's medication history and outcomes.

Dr. Newby's analysis included 2,091 women and 5,084 men enrolled in the SYMPHONY trials in the US. She found that 63 percent of women had hypertension, compared to 50 percent of the men. The women with hypertension tended to be older, had reduced kidney function, and more often had diabetes and a history of heart failure when compared to men.

However, women had fewer previous heart attacks or invasive procedures to improve blood flow to the heart.

"What we found so interesting was that women received more and different agents to reduce blood pressure than did the men," Dr. Newby said. "What is confusing is that this difference in the number of drugs to control hypertension still did not have any significant effect, when compared to the men."

The classes of medications used most often to control blood pressure were ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics.

Specifically, 16 percent of the women were prescribed three different medications to control hypertension, compared to 13 percent for men. Almost 35 percent of women received two different medications, compared to 30 percent for men.

Only  one type of medication, diuretics, appeared to be prescribed to women more often than to men - 33 percent in women compared to 19 percent in men.

"While women were more likely to get multi-drug treatments, they still had higher blood pressures," Dr. Newby says. Systolic pressure was 150 millimeters of mercury (mmHg) at presentation in women and 147 mmHg in men, she reports.

Even after treatment for the ACS, blood pressure remained higher in women (126 mmHg vs. 124 mmHg in men).

Finding Best Treatment for Women a Goal

"Thus, it is not clear if women are not getting the right medicines, are getting them in the wrong doses, or if other factors are responsible for the need for more medications in women to attain similar control," Dr. Newby says.

Dr. Newby says that physicians need to be aggressive in treating hypertension, whether their patients are male or female. She added that awareness of the disease, both on the part of physicians and patients, is important to reducing the prevalence of hypertension and therefore reduce the risk for heart attacks.

"Hypertension is often forgotten about, a silent disease," she says. "Awareness may be the key, since the disease itself does not make patients feel bad. A lack of awareness affects compliance with medications, going to the doctor for check-ups, eating healthful meals, all those things that are helpful in keeping hypertension in control."

Always consult your physician for a diagnosis.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

American Heart Association

American Society of Hypertension

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Institutes of Health (NIH)

National Women's Health Information Center

Office of Research on Women's Health

January 2004

Women Face Challenges In Controlling Hypertension

Researchers Look at Data from Earlier Studies

Finding Best Treatment for Women a Goal

Blood Pressure Explained

Heart Attack In Women

Online Resources

Blood Pressure Explained

Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider, is the force of the blood pushing against the artery walls.

Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts.

An electronic blood pressure monitoring device may be used when an individual takes his/her own blood pressure. Electronic blood pressure monitors may also measure the heart rate, or pulse.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body.

The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mmHg" (millimeters of mercury). This recording represents how high the mercury column is raised by the pressure of the blood.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), high blood pressure for adults is defined as:

140 mmHg or greater systolic pressure

and

90 mmHg or greater diastolic pressure

In an update of NHLBI guidelines for hypertension in 2003, a new blood pressure category was added called prehypertension:

120 mmHg – 139 mmHg systolic pressure

and

80 mmHg – 89 mmHg diastolic pressure

The new NHLBI guidelines now define normal blood pressure as follows:

Less than 120 mmHg systolic pressure

and

Less than 80 mmHg diastolic pressure

These numbers should be used as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem.

A physician will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension (high blood pressure) and initiating treatment.

Always consult your physician for more information.

Heart Attack In Women

It is a myth that heart disease is a man's disease. In fact, cardiovascular diseases are the number one killer of women.

These diseases currently claim the lives of more than a half a million females every year - more than the next 16 causes of death combined.

In 64 percent of women who died suddenly from cardiovascular disease, there were no previous symptoms of the disease.

According to the  the American Heart Association:

Forty-one percent of all deaths in women occur from cardiovascular disease.

In the US, cardiovascular diseases claim the lives of nearly 506,000 women annually, while all forms of cancer combine to kill about 267,000 women.

Coronary heart disease is the single largest cause of death for women in the US.

About 18,900 women under age 65 die of coronary heart disease each year; about 35 percent of them are under age 55.

Always consult your physician for more information.