Lower levels of elevated BP more harmful in women vs. men
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In women, systolic BP as low as 100 mm Hg to 109 mm Hg may be associated with CVD risk, according to a study published in Circulation.
In contrast, the same level of CVD risk was not observed in men until the systolic BP range of 130 mm Hg to 139 mm Hg, the researchers wrote, noting the findings may be a reason to reassess prevention strategies related to BP.
Clinical importance
“Our results indicate that the same degrees of elevated BP have different clinical implications for women vs. men and, in particular, that women are at greater risk for cardiovascular disease events starting at a lower BP threshold than men — and, in fact, a BP threshold below what has previously been considered to be ‘normal,’” Cardiology Today Editorial Board Member Susan Cheng, MD, MPH, MMSc, associate professor of cardiology and director of public health research at the Smidt Heart Institute at Cedars-Sinai, told Healio. “We and others have shown that the normal range of healthy systolic BP is lower in women compared to men. Extending from these previous observations, it now makes sense that we would find that deviations above a lower range of normal are potentially more clinically important for women compared to men.”
Researchers evaluated standardized systolic BP measurements from 27,542 adult participants (54% women) without baseline CVD from four community-based cohort studies. Over the duration of the study periods, 7,424 participants (44% women) developed nonfatal or fatal CVD: 3,405 had MI events, 4,081 had HF events and 1,901 had stroke events.
Participants were stratified by 10 mm Hg increments into systolic BP categories from less than 100 mm Hg to at least 160 mm Hg, and the tiers were compared by CVD events, with the less than 100 mm Hg tier as reference.
In analyses combining both sexes, elevated risk for incident MI and HF began at 120 mm Hg to 129 mm Hg, and elevated risk for stroke began at 130 mm Hg to 139 mm Hg, the researchers wrote.
Sex-specific analyses
When evaluating sex-specific analyses, researchers observed an increased CVD risk at lower systolic BP thresholds for women compared with men. Incident CVD risk was associated with systolic BP 100 mm Hg to 109 mm Hg compared with less than 100 mm Hg in women, but in men, incident CVD risk compared with systolic BP less than 100 mm Hg did not begin until systolic BP 130 mm Hg to 139 mm Hg, according to the researchers.
Put another way, Cheng and colleagues wrote, the HR for CVD in women with systolic BP 100 mm Hg to 109 mm Hg was 1.25, very similar to the HR of 1.26 for CVD in men with systolic BP of 130 mm Hg to 139 mm Hg.
Similar sex-specific results were found for MI, HF and stroke; for example, Cheng and colleagues wrote, MI risk in women with systolic BP 110 mm Hg to 119 mm Hg was similar to MI risk in men with systolic BP 160 mm Hg or more.
There were larger BP-related associations with risk in women compared with men across all CVD outcomes, with the strongest associations observed for MI (P = .006) and HF (P = .058), the researchers wrote.
The researchers also observed a more pronounced association of systolic BP with CVD risk among younger women compared with older women (median age, < 52 years vs. > 52 years; P < .001). There was no age interaction observed in men (P = .098).
“Our findings suggest that we need to take an approach to managing BP elevation that takes into account whether the patient is a woman or a man,” Cheng said in an interview. “Our results suggest that it may well be beneficial to have a lower target BP in women compared to men, at least under certain circumstances, although we would need more prospective interventions-based studies (ie, clinical trials) to properly and rigorously investigate this important question.”
For more information:
Susan Cheng, MD, MPH, MMSc, can be reached at susan.cheng@cshs.org.
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