Intensive therapy may blunt higher CVD risk for younger women with hypertension, diabetes
Click Here to Manage Email Alerts
Key takeaways:
- Women with type 2 diabetes have a higher risk for CVD events if they are diagnosed with hypertension before age 50 years.
- Younger women with type 2 diabetes and hypertension may benefit from intensive therapy.
Women with type 2 diabetes diagnosed with hypertension at younger than age 50 years have an increased risk for cardiovascular disease and could benefit from intensive antihypertension therapy according to data published in Diabetes Care.
In a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the risk for CVD events increased by 11% for every 10 years younger that a person was diagnosed with hypertension. However, an increased CVD event risk with younger hypertension diagnosis was only observed among women and not men.
“The findings specifically remind us to be especially thoughtful about how any patient with early-onset hypertension — and now especially on a background of diabetes and if they are a woman — that more rather than less watchful monitoring and management of risk measures such as blood pressure is likely to be helpful,” Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the department of cardiology, Smidt Heart Institute at Cedars-Sinai, told Healio.
Cheng and colleagues obtained data from 3,792 participants in ACCORD who provided their age at hypertension diagnosis (49% women). Early hypertension was defined as a diagnosis at younger than 50 years, whereas a late diagnosis was at age 50 years or older. CVD events included coronary heart disease, stroke, heart failure or CV death.
During a median follow-up of 4.5 years, adults had a higher risk for a CVD event with each 10 years younger age at diagnosis (HR = 1.11; 95% CI, 1.03-1.21; P = .006). In sex-stratified analysis, women diagnosed with hypertension before age 50 years had a higher risk for a CVD event than women diagnosed at age 50 years or older (HR = 1.47; 95% CI, 1.12-1.92; P = .005), but no association was observed for men.
Women who were diagnosed with hypertension before age 50 years and were prescribed intensive antihypertensive therapy had a lower risk for a CVD event than those receiving standard therapy (HR = 0.65; 95% CI, 0.43-0.97; P = .036).
Cheng said prior studies have shown that women have a lower range for normal BP than men, but researchers remain uncertain as to whether providers should treat hypertension to different targets between men and women and for those with conditions such as diabetes.
“It may be possible that at least certain women, in this case women with diabetes who developed hypertension earlier in life, may benefit from having their BP controlled to the level that is closer to the physiological normal range seen in healthy women,” Cheng said. “For women whose hypertension developed later in life, the pathophysiology and contextual comorbidity profile may be different to the extent that they should be treated less aggressively. There is certainly the need for more studies to further clarify these issues.”
Cheng said more basic and translational studies are needed to understand the mechanisms for the findings in the study.
“We also need more clinical studies to not only validate the findings, but also prospectively test, ideally in a randomized manner, how more compared to less strict BP targets may be beneficial as well as safe for women vs. men with hypertension in the setting of not only diabetes, but also prediabetes, metabolic syndrome and a range of other clinical situations,” Cheng said.
For more information:
Susan Cheng, MD, MPH, can be reached at susan.cheng@cshs.org.
Collapse
Click Here to Manage Email Alerts