Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

Spatio-Temporal Variation of Gender-Specific Hypertension Risk: Evidence from China

Previous studies which have shown the existence of gender disparities in hypertension risks often failed to take into account the participants' spatial and temporal information. In this study, we explored the spatio-temporal variation for gender-specific hypertension risks in not only single-disease settings but also multiple-disease settings. From the longitudinal data of the China Health and Nutrition Survey (CHNS), 70,374 records of 21,006 individuals aged 12 years and over were selected for this study. Bayesian B-spline techniques along with the Besag, York, and Mollie (BYM) model and the Shared Component Model (SCM) model were then used to construct the spatio-temporal models. Our study found that the prevalence of hypertension in China increased from 11.7% to 34.5% during 1991 and 2015, with a higher rate in males than that in females. Moreover, hypertension was found mainly clustered in spatially adjacent regions, with a significant high-risk pattern in Eastern and Central China while a low-risk pattern in Western China, especially for males. The spatio-temporal variation of hypertension risks was associated with regional covariates, such as age, overweight, alcohol consumption, and smoking, with similar effects of age shared by both genders whereas gender-specific effects for other covariates. Thus, gender-specific hypertension prevention and control should be emphasized in the future in China, especially for the elderly population, overweight population, and females with a history of alcohol consumption and smoking who live in Eastern China and Central China.

Regulation of blood pressure is influenced by gender: A study in obese Zucker rats

AIM

The present study determined the role of renin-angiotensin system (RAS), endothelin system, and eicosanoid system in the blood pressure (BP) regulation in male and female Zucker rats, and whether the pressor response change similarly in lean and obese animals.

MATERIAL AND METHODS

In female (f) and male (m), lean (L) and obese (O) Zucker rats (ZR) at 22 weeks old, we evaluated the role of the 3 mentioned systems using the following treatments: 1) enalapril (angiotensin I converting enzyme inhibitor), 2) the ABT-627 (endothelin receptor A (ET_A) antagonist), and 3) the 1-aminobenzotriazol (1-ABT: eicosanoid synthesis inhibitor).

KEY FINDINGS

MAP by radiotelemetry was similar and significantly higher in mOZR (120 ± 2 mm Hg) and fOZR (116 ± 4 mm Hg) (p < 0.05 vs. m-, fLZR), than mLZR (105 ± 3 mm Hg) and fLZR (106 ± 1 mm Hg), that were also similar. Enalapril reduced MAP more in mOZR (23%) and mLZR (26%), than fLZR (20%, p < 0.905 vs. mLZR) or fOZR (9%; p < 0.05 vs. other groups). After 10 days of drug-free and recovery period, ABT-627 reduced MAP in fLZR and mLZR by similar amounts (102 ± 4 to 92 ± 3 mm Hg, n = 6; p < 0.05 and 105 ± 2 vs. 92 ± 3 mm Hg, n = 6; p < 0.05, respectively), but did not affect either fOZR or mOZR. After another 10 days of drug-free and recovery period, 1-ABT reduced MAP in fOZR (116 ± 4 to 95 ± 2, n = 6; p < 0.05), and did not affect all other groups.

SIGNIFICANCE

We show that the mechanisms responsible for elevated BP in male and female OZR and LZR are different, and suggest that obesity may cause an increase in BP via different mechanisms in men and women as well.

Effects of Different Dietary and Lifestyle Modification Therapies on Metabolic Syndrome in Prediabetic Arab Patients: A 12-Month Longitudinal Study

This three-arm, randomized, controlled study aimed to determine the differences in the effects of general advice (GA) on lifestyle change, intensive lifestyle modification programme (ILMP) and GA + metformin (GA + Met) in reducing the prevalence of full metabolic syndrome (MetS) in subjects with prediabetes; 294 Saudis with prediabetes (fasting glucose 5.6–6.9 mmol/L) were initially randomized, 263 completed 6 months and 237 completed 12 months. They were allocated into three groups: GA group which received a standard lifestyle change education; ILMP which followed a rigorous lifestyle modification support on diet and physical activity; and a GA + Met group. Anthropometric and biochemical estimations were measured. Full MetS (primary endpoint) and its components (secondary endpoint) were screened at baseline, 6 and 12 months. Full MetS in the ILMP group decreased by 26% (p < 0.001); in GA + Met group by 22.4% (p = 0.01) and in GA group by 8.2% (p = 0.28). The number of MetS components decreased significantly in the ILMP and GA + Met groups (mean change 0.81, p < 0.001 and 0.35, p = 0.05, respectively). Between-group comparison revealed a clinically significant decrease in MetS components in favor of the ILMP group (−0.58 (−0.88–0.28), p < 0.001). This study highlights the clinical potency of ILMP versus other diabetes prevention options in reducing MetS in Saudi adults with elevated fasting glucose.

Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study

Background

Although several studies have identified risk factors for high blood pressure (BP), data from Afro-Caribbean populations are limited. Additionally, less is known about how putative risk factors operate in young adults and how social factors influence the risk of high BP. In this study, we estimated the relative risk for elevated BP or hypertension (EBP/HTN), defined as BP ≥ 120/80 mmHg, among young adults with putative cardiovascular disease (CVD) risk factors in Jamaica and evaluated whether relative risks differed by sex.

Methods

Data from 898 young adults, 18–20 years old, were analysed. BP was measured with a mercury sphygmomanometer after participants had been seated for 5 min. Anthropometric measurements were obtained, and glucose, lipids and insulin measured from a fasting venous blood sample. Data on socioeconomic status (SES) were obtained via questionnaire. CVD risk factor status was defined using standard cut-points or the upper quintile of the distribution where the numbers meeting standard cut-points were small. Relative risks were estimated using odds ratios (OR) from logistic regression models.

Results

Prevalence of EBP/HTN was 30% among males and 13% among females (p < 0.001 for sex difference). There was evidence for sex interaction in the relationship between EBP/HTN and some of risk factors (obesity and household possessions), therefore we report sex-specific analyses. In multivariable logistic regression models, factors independently associated with EBP/HTN among men were obesity (OR 8.48, 95% CI [2.64–27.2], p < 0.001), and high glucose (OR 2.01, CI [1.20–3.37], p = 0.008), while high HOMA-IR did not achieve statistical significance (OR 2.08, CI [0.94–4.58], p = 0.069). In similar models for women, high triglycerides (OR 1.98, CI [1.03–3.81], p = 0.040) and high HOMA-IR (OR 2.07, CI [1.03–4.12], p = 0.039) were positively associated with EBP/HTN. Lower SES was also associated with higher odds for EBP/HTN (OR 4.63, CI [1.31–16.4], p = 0.017, for moderate vs. high household possessions; OR 2.61, CI [0.70–9.77], p = 0.154 for low vs. high household possessions). Alcohol consumption was associated with lower odds of EBP/HTN among females only; OR 0.41 (CI [0.18–0.90], p = 0.026) for drinking <1 time per week vs. never drinkers, and OR 0.28 (CI [0.11–0.76], p = 0.012) for drinking ≥3 times per week vs. never drinkers. Physical activity was inversely associated with EBP/HTN in both males and females.

Conclusion

Factors associated with EBP/HTN among Jamaican young adults include obesity, high glucose, high triglycerides and high HOMA-IR, with some significant differences by sex. Among women lower SES was positively associated with EBP/HTN, while moderate alcohol consumption was associated lower odds of EBP/HTN.

Perceived Racism and Ambulatory Blood Pressure in African American College Students

Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment from which daytime and nighttime averages were computed. Perceived frequency of experiences with racism and racial discrimination was measured using the Perceived Racism Scale. Controlling for gender and body mass index, perceived racism in academic settings was associated with higher diastolic BP (DBP) during waking hours and nighttime sleep. Systolic BP (SBP) was unrelated to perceived racism, and perceived racism in the public realm and in statements from Whites was unrelated to ABP. Perceived racism in academic settings predicted ambulatory DBP among college students. Previous laboratory research has found stronger effects of perceived racism for DBP than SBP. The hemodynamic regulation of BP may explain this phenomenon. Future laboratory and ambulatory studies should assess the contributions of vascular resistance and cardiac output to BP elevations associated with perceived racism.

Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time?

Hypertension is common in patients with chronic kidney disease (CKD) and is the most important modifiable risk factor for CKD progression and adverse cardiovascular events in these patients. Diagnosis and successful management of hypertension are critically dependent on accurate blood pressure (BP) measurement. This is most relevant to CKD patients, in whom BP control is difficult to achieve and in whom early antihypertensive treatment is imperative to prevent kidney and cardiovascular complications. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting hypertension than office BP measurement. ABPM is also a superior prognostic marker compared with office BP and has successfully identified hypertensive CKD patients at increased risk. Additionally, ABPM provides information on circadian BP variation and short-term BP variability, which is associated with cardiovascular and renal outcomes. This paper reviews the evidence for the usefulness of ABPM in detection and management of hypertension in CKD patients and discusses our current understanding of the pathophysiology of altered circadian BP rhythm and variability in CKD and the role of abnormal BP patterns detected by ABPM in relation to outcomes in CKD. In addition, this Review examines the emerging role of antihypertensive chronotherapy to tailor BP management to the circadian BP pattern abnormality detected by 24-hour ABPM.

Spatial analysis of gender variation in the prevalence of hypertension among the middle-aged and elderly population in Zhejiang Province, China

Background

Previous studies have shown that there may be gender disparities in the prevalence of hypertension; however, these studies do not address the spatial information contained in the sample which may limit the analytical results. Our study extends the existing Shared Component Model (SCM) and compares its utility with a logistic regression model to evaluate the significance of spatial information for identifying risk factors for hypertension and other non-rare diseases.

Methods

A total of 1267 residents aged 45 years of age and over were included in our study, of which 48.1 % were males. The overall prevalence of hypertension was 33.2 %, with females experiencing a higher prevalence than males (35.5 % vs. 30.6 %). The research variables included body mass index (BMI), Waist -to-Height Ratio (WHtR), smoking status, alcohol consumption etc. The extended SCM is employed to investigate regional gender variations in the risk of hypertension and assess the gender variation in the middle-aged and elderly populations of Zhejiang Province in eastern China and then its performance is compared with that of a traditional multiple logistic regression model.

Results

Our SCM analysis determined that the spatial pattern of hypertension risk for the middle-aged and elderly populations of Zhejiang Province in eastern China is quite different for males and females. Furthermore, Waist -to-Height Ratio (WHtR) continues to be a simple and effective predictor of hypertension risk for males at the regional level.

Conclusions

We believe that the extended SCM spatial model is a useful tool for identifying risk factors at the regional level.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3121-y) contains supplementary material, which is available to authorized users.

Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults

New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past cardiovascular events, the thresholds are even lower by 15/10 mmHg, i.e., 105/60 mmHg. Bedtime treatment with the full daily dose of ≥1 hypertension medications is recommended as a cost-effective means to improve the management of hypertension and reduce hypertension-associated risk. Bedtime treatment entailing the full daily dose of ≥1 conventional hypertension medications must be the therapeutic regimen of choice for the elderly and those with diabetes, resistant and secondary hypertension, chronic kidney disease, obstructive sleep apnea, and medical history of past cardiovascular events, among others, given their documented high prevalence of sleep-time hypertension.

Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients

This study aimed to investigate the effects of gender on the association between epicardial fat thickness (EFT) and circadian blood pressure (BP) changes in patients with recently diagnosed essential hypertension (EH). A total of 441 patients with EH (male/female: 236/205, mean age: 50.7 ± 13.8) and 83 control patients underwent 24-hour ambulatory BP monitoring and echocardiography. Obese EH patients had higher circadian BP profile with BP variability, wall thickness, and left ventricular mass than nonobese EH patients and controls (all p's <0.05) without gender differences. EFT was higher in female than in male patients (7.0 ± 2.5 versus 5.9 ± 2.2 mm, p < 0.001) and higher in the obese female EH group (7.5 ± 2.6 mm) than in the control (6.4 ± 2.8 mm) or nonobese EH group (6.7 ± 2.8 mm) among women, whereas EFT did not vary among males (5.9 ± 1.9 versus 6.0 ± 2.7 versus 5.9 ± 2.4 mm, p = 0.937). Multivariate logistic regression analysis demonstrated that the 24-hour mean BP variability was associated with SBP (p = 0.018) and EFT (p = 0.016) in female patients, but not in male patients. The relationships among circadian BP variability, obesity, and EFT were affected by gender in different manners. EFT may be a more valuable parameter in the evaluation of BP severity and obesity in women than in men.

Night blood pressure responses to atenolol and hydrochlorothiazide in black and white patients with essential hypertension

BACKGROUND

Night blood pressure (BP) predicts patient outcomes. Variables associated with night BP response to antihypertensive agents have not been fully evaluated in essential hypertension.

METHODS

We sought to measure night BP responses to hydrochlorothiazide (HCTZ), atenolol (ATEN), and combined therapy using ambulatory blood pressure (ABP) monitoring in 204 black and 281 white essential hypertensive patients. Initial therapy was randomized; HCTZ and ATEN once daily doses were doubled after 3 weeks and continued for 6 more weeks with the alternate medication added for combined therapy arms. ABP was measured at baseline and after completion of each drug. Night, day, and night/day BP ratio responses (treatment - baseline) were compared in race/sex subgroups.

RESULTS

Baseline night systolic BP and diastolic BP, and night/day ratios were greater in blacks than whites (P < 0.01, all comparisons). Night BP responses to ATEN were absent and night/day ratios increased significantly in blacks (P < 0.05). At the end of combined therapy, women, blacks, and those starting with HCTZ as opposed to ATEN had significantly greater night BP responses (P < 0.01). Variables that significantly associated with ATEN response differed from those that associated with HCTZ response and those that associated with night BP response differed from those that associated with day BP response.

CONCLUSIONS

In summary, after completion of HCTZ and ATEN therapy, women, blacks, and those who started with HCTZ had greater night BP responses. Reduced night BP response and increased night/day BP ratios occured with ATEN in blacks. Given the prognostic significance of night BP, strategies for optimizing night BP antihypertensive therapy should be considered.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT00246519.

Glucose abnormalities associated with impaired nocturnal fall in blood pressure in normotensive severely obese patients

BACKGROUND

The purpose of this study was to identify factors affecting the nocturnal decline in blood pressure (BP) in severe obesity.

METHODS

Clinical, biochemical, polysomnographic data, glucose tolerance status, and body fat composition were obtained in 82 candidates for bariatric surgery (mean age: 40 (11) years; BMI: 46 (4)kg/m(2)). To determine the nocturnal BP fall we used 24-h ambulatory BP monitoring to measure the magnitude (Δ) of nocturnal decline, the % day-night systolic BP (SBP) and diastolic BP (DBP), dipper status and nocturnal hypertension (HT).

RESULTS

Twenty-three percent of patients had nocturnal HT. Sixty percent had non dipper status, of which 95% had nocturnal HT. No specific factors were associated with the average 24-h SBP and DBP. Having glucose abnormalities was of primary importance for all variables evaluating nocturnal BP decline independent of daytime BP levels and severity of obesity. In comparing patients with or without glucose tolerance abnormalities, the night-time SBP and DBP were significantly higher and the Δ nocturnal decline and % day-night in both SBP and DBP were significantly lower in those with glucose tolerance abnormalities. In an adjusted multivariate model, having both glucose abnormalities and nocturnal HT remained associated with non dipper status with an OR of 3.13 (95% CI 1.11-8.87, p=0.03) and 14.93 (95% CI 1.77-125.62, p=0.001), respectively.

CONCLUSION

In normotensive severely obese patients, non dipper status and nocturnal HT are common, and the presence of glucose abnormalities was the primary variable associated with impaired nocturnal fall in BP.

Differences between men and women in ambulatory blood pressure thresholds for diagnosis of hypertension based on cardiovascular outcomes

Previous studies have reported sex differences in the pathophysiology of hypertension and responses to blood pressure (BP)-lowering medications. Moreover, men exhibit typically higher BP than women, the differences being greater for systolic (SBP) than diastolic (DBP) BP. These differences become apparent during adolescence and remain significant at least until 55-60 yrs of age. Despite such significant sex-related differences in BP regulation, the current recommended ambulatory BP monitoring (ABPM) thresholds for diagnosis of hypertension do not differentiate between men and women. We aimed to derive separate male and female diagnostic thresholds for the awake and asleep SBP and DBP means based upon cardiovascular disease (CVD) outcome. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 yrs of age, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every minute by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Cox regression analysis was used to derive outcome-based reference thresholds for ABPM in men and women. Men exhibited greater event rates than women of CVD death, myocardial infarction, angina pectoris, coronary revascularization, and heart failure; however, event rates of non-CVD death and cerebrovascular events were comparable. The relationship between progressively higher ambulatory BP and CVD risk increased more rapidly in women than men for awake SBP/DBP means ≥125/75 mm Hg and asleep means ≥110/70 mm Hg. The derived outcome-based reference thresholds for men were 135/85 mm Hg for the awake and 120/70 mm Hg for the asleep SBP/DBP means. In terms of CVD outcome, the equivalent cutoff threshold values for women were 125/80 mm Hg for the awake and 110/65 mm Hg for the asleep SBP/DBP means. Outcome-based reference thresholds for the diagnosis of hypertension were 10/5 mm Hg lower for ambulatory SBP/DBP in women than men. This marked sex difference indicates the need for revision of current guidelines that propose diagnostic thresholds for ambulatory BP without differentiation between men and women.

Blood pressure dipping: ethnicity, sleep quality, and sympathetic nervous system activity

BACKGROUND

Blunted blood pressure (BP) dipping is an established predictor of adverse cardiovascular outcomes. Although blunted BP dipping is more common in African Americans than whites, the factors contributing to this ethnic difference are not well understood. This study examined the relationships of BP dipping to ethnicity, body mass index (BMI), sleep quality, and fall in sympathetic nervous system (SNS) activity during the sleep-period.

METHODS

On three occasions, 128 participants with untreated high clinic BP (130-159/85-99 mm Hg) underwent assessments of 24-h ambulatory BP (ABP), sleep quality, (evaluated by sleep interview, self-report, actigraphy) and sleep-period fall in sympathetic activity (measured by waking/sleep urinary catecholamine excretion).

RESULTS

Compared to whites (n = 72), African Americans (n = 56) exhibited higher sleep-period systolic (SBP) (P = 0.01) and diastolic BP (DBP) (P < 0.001), blunted SBP dipping (P = 0.01), greater BMI (P = 0.049), and poorer sleep quality (P = 0.02). SBP dipping was correlated with BMI (r = -0.32, P < 0.001), sleep quality (r = 0.30, P < 0.001), and sleep-period fall in sympathetic activity (r = 0.30, P < 0.001). Multiple regression analyses indicated that these three factors were independent determinants of sleep-period SBP dipping; ethnic differences in dipping were attenuated when controlling for these factors.

CONCLUSIONS

Blunted BP dipping was related to higher BMI, poorer sleep quality, and a lesser decline in sleep-period SNS activity. Although African-American ethnicity also was associated with blunted dipping compared to whites in unadjusted analyses, this ethnic difference was diminished when BMI, sleep quality, and sympathetic activity were taken into account.

Ambulatory blood pressure monitoring in diabetes and obesity-a review

Diabetes mellitus and obesity are both related to the risk of cardiovascular disease and sudden death. In hypertensive guidelines, diabetes and obesity, especially abdominal obesity, are regarded as high-risk factors. Ambulatory blood pressure monitoring (ABPM) is an established method for the management of hypertension. However, ABPM is not a standard tool for the management of hypertension in diabetes and obesity. In this paper, recent data on the use of ABPM in diabetes and obesity will be discussed. In patients with diabetes, the ambulatory BP level has been shown to be better than clinic BP in predicting cardiovascular events. A riser pattern has been associated with increased risk of cardiovascular disease. White-coat hypertension and masked hypertension in diabetics constitute a moderate risk. A nondipping pattern is very common in obese hypertensive patients. In this paper, we will summarize the findings on the use of ABPM in patients with diabetes and obesity.

Leptin is associated with blood pressure and hypertension in women from the National Heart, Lung, and Blood Institute Family Heart Study

Leptin is a key neuroendocrine hormone regulating food intake, metabolism, and fat accumulation, and it may also affect blood pressure and contribute to hypertension through sympathetic activation in the vasculature or at the renal level. Although previous studies have shown that the distribution of leptin is significantly different between males and females, as is the risk of hypertension between males and females, results regarding the role of leptin in the gender-specific regulation of blood pressure are controversial. Thus, we performed family-based association analyses in the National Heart, Lung, and Blood Institute Family Heart Study to test the hypothesis that LEPTIN gene variants and the plasma leptin level influence variability in blood pressure and the risk of hypertension differently by gender. We identified significant associations between LEPTIN single nucleotide polymorphisms with blood pressure and hypertension, but in postmenopausal women only. We also identified significant associations between plasma leptin levels and both blood pressure and hypertension in women. The current study supports a role for LEPTIN and plasma leptin levels in blood pressure regulation in women. It also provides insight into the gender differences in hypertension, as well as the differential distribution and activity of leptin in men and women.

Gender differences in office and ambulatory control of hypertension

BACKGROUND

Gender differences in hypertension control have not been explored fully.

METHODS

We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night).

RESULTS

Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P<.001). Women had a lower frequency of masked hypertension (office BP<140/90 mm Hg and ambulatory BP> or =130/80 mm Hg) than men (5.9% vs 7.9%, P<.001). Women had a higher frequency of isolated office hypertension (office BP> or =140/90 mm Hg and ambulatory BP<130/80 mm Hg) (32.5% vs 24.2%, P<.001). Although office BP control (office BP<140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P=.542), ambulatory BP control (ambulatory BP<130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P<.001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged.

CONCLUSION

Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.

Sex differences in ambulatory blood pressure monitoring

PURPOSE

Referral to ambulatory blood pressure monitoring may have bearing upon blood pressure control and prognosis. We describe sex-related differences in referral for ambulatory monitoring and their prognostic impact.

METHODS

Between 1991 and 2005, 3957 patients were monitored in our ambulatory monitoring service, of whom 2114 (53%) were women. Demographic and clinical data were analyzed according to sex.

RESULTS

Age (58+/-15 vs 52+/-17 years, respectively) and body mass index (27.5+/-4.9 vs 26.9+/-4.0 kg/m(2), respectively) were higher in women than men. Treatment for hypertension was more prevalent in women (62% vs 53%, respectively). Clinic systolic blood pressure (148+/-24 vs 146+/-20 mm Hg, respectively) and clinic pulse pressure (65+/-22 vs 59+/-18 mm Hg, respectively) were higher in women compared with men. In women, the white-coat effect was increased, compared with men; 5.2+/-12.4% vs 1.5+/-10.7% systolic, and 5.4+/-11.2% vs 3.6+/-10.3% diastolic. Consequently, women had lower ambulatory blood pressure than men. In women, 24-hour blood pressure was 136+/-17/76+/-10 vs 140+/-15/81+/-10 mm Hg in men, awake blood pressure 141+/-17/80+/-11 vs 144+/-15/84+/-10 mm Hg, and sleep blood pressure was 125+/-19/67+/-10 vs 127+/-18/71+/-11 mm Hg. Age-adjusted ambulatory blood pressure also was lower in women. Ambulatory heart rate was higher in women (P <.0001). Kaplan-Meier survival did not differ by sex (P=.66), despite older age and higher clinic blood pressure.

CONCLUSIONS

The results might imply that referral was driven by the physicians' overall patient risk perception. The greater magnitude of white-coat effect in women, and correspondingly lower ambulatory blood pressure, might in part account for similar mortality in the face of older age and higher clinic blood pressure.