High-normal blood pressure in midlife is a stronger risk factor for incident hypertension 26 years later in women than men: the Hordaland Health Study.

PURPOSE: To identify modifiable risk factors in early midlife associated with incident hypertension 26 years later in women and men. MATERIALS AND METHODS: We used data from 1025 women and 703 men in the community-based Hordaland Health Study examined at the mean age of 42 years (baseline) and after a 26-year follow-up. Patients with hypertension at baseline were excluded. Blood pressure (BP) was classified according to European guidelines. Factors associated with incident hypertension were identified in logistic regression analyses. RESULTS: At baseline, women had a lower average BP and a lower prevalence of high-normal BP (19% vs 37%, p < .05). Overall, 39% of women and 45% of men developed hypertension during follow-up (p < .05). Among those with high-normal BP at baseline, 72% of women and 58% of men developed hypertension (p < .01). In multivariable logistic regression analyses, high-normal BP at baseline was a stronger predictor of incident hypertension in women (odds ratio, OR 4.8, [95% confidence interval, CI 3.4-6.9]) than in men (OR 2.1, [95% CI 1.5-2.8]), p < .01 for sex interaction. A higher baseline body mass index (BMI) was associated with incident hypertension in both sexes. CONCLUSIONS: High-normal BP in midlife is a stronger risk factor for developing hypertension 26 years later in women than in men, independent of BMI.

There is a knowledge gap regarding the understanding of sex differences in hypertension and cardiovascular disease. The World Health Organisation has identified hypertension as the leading cause of morbidity and mortality in women.This manuscript focuses on sex differences in risk factors in early midlife associated with the development of hypertension 26 years later. We studied 1025 women and 703 men who participated in the community-based Hordaland Health Study at the age of 42 years, and after 26 years. Factors associated with hypertension were identified in statistical analyses.Our main findings were that having a high-normal blood pressure (systolic blood pressure 130­139 mmHg or a diastolic blood pressure 85­89 mmHg) in midlife was a significantly stronger risk factor for the development of hypertension in women than in men during follow-up. Having a higher body mass index in midlife was associated with the development of hypertension in both sexes.This study contributes to the understanding of sex differences in hypertension development and adds further knowledge regarding high-normal blood pressure as a particularly important risk factor for hypertension and cardiovascular disease in women.

Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence.

INTRODUCTION: Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear. METHODS: We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication. RESULTS: Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12-4.00] p = 0.02). CONCLUSIONS: Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence. REGISTRATION: URL:  https://www. CLINICALTRIALS: gov ; Unique identifier: NCT03209154.