Comparison of Clinical Outcomes Between Genders Following Antihypertensive Therapy: A Meta-Analysis

Analysis of Gender-Based Inequality in Cardiovascular Health: An Umbrella Review

This umbrella review aims to investigate possible gender-based inequality in cardiovascular health and improve understanding surrounding differing presentations seen in women. Searches of current literature were conducted using Medline; Cochrane; Cumulative Index of Nursing and Allied Health Literature (CINAHL Plus); and PubMed databases. Focusing on systematic reviews and meta-analyses from the last decade, searches were expanded to the publication year of 2000 onwards, to enable a broader review of current practices. Current clinical guidelines were also reviewed. 17 articles were deemed to satisfy the desired criteria and were therefore carried forward to be critically appraised. The articles reviewed were multifactorial; however, they can be grouped into four categories of common focus: risk factors, presentation, treatment, and current research. On critical analysis, 13 reoccurring themes were noted throughout the reviewed articles with each discussed in detail within this review. There is a need to prioritize women in cardiovascular health, through raising awareness, improving prevention (both primary and secondary), reducing delays in presentation, and increasing understanding and recognition of sex differences in symptom presentation, to enable improved diagnosis and treatment along with the standardization of gender-specific clinical guidance. The results are unanimous regarding an undeniable gender-based inequality in cardiovascular health to the detriment of women. With such damning evidence that women are under-represented and indeed undertreated, the time has come now to question whether women should be considered as their own specialty within cardiology and to ultimately raise awareness and ensure women are given the same consideration regarding cardiovascular disease (CVD) risk assessment and treatment, in order to finally remove gender inequality in cardiovascular (CV) health. In order to reverse this disparity, it is clear from the included studies that further research is required to understand the sex differences seen in both the presentation and symptoms of CVD as well as to enable improved treatment of women and the development of sex-specific strategies and clinical guidance to empower clinicians moving forward.

Statin therapy and sex hormones

Current guidelines recommend statin therapy for all adult patients with coronary artery disease irrespective of sex. Over recent years, some concerns have been raised concerning the effects of statins on endogenous steroid hormones synthesis. The aim of this review was to summarize the effects of statins on endogenous sex hormones in order to clarify their role and safety in different clinical settings. Results suggest that HMG-CoA inhibitors may slightly impair adrenal and/or gonadal steroid hormone production. In men, statins do not cause any clinically-relevant harmful effects on erectile function and spermatogenesis and, in women, statins have beneficial effects in treatment of polycystic ovary syndrome (PCOS). Additional research is needed to provide specific clinical recommendations concerning this topic.

Computational and Pharmacogenomic Insights on Hypertension Treatment: Rational Drug Design and Optimization Strategies

Background::

Hypertension is a prevalent cardiovascular complication caused by genetic and nongenetic factors. Blood pressure (BP) management is difficult because most patients become resistant to monotherapy soon after treatment initiation. Although many antihypertensive drugs are available, some patients do not respond to multiple drugs. Identification of personalized antihypertensive treatments is a key for better BP management.

Objective::

This review aimed to elucidate aspects of rational drug design and other methods to develop better hypertension management.

Results::

Among hypertension-related signaling mechanisms, the renin-angiotensin-aldosterone system is the leading genetic target for hypertension treatment. Identifying a single drug that acts on multiple targets is an emerging strategy for hypertension treatment, and could be achieved by discovering new drug targets with less mutated and highly conserved regions. Extending pharmacogenomics research to include patients with hypertension receiving multiple antihypertensive drugs could help identify the genetic markers of hypertension. However, available evidence on the role of pharmacogenomics in hypertension is limited and primarily focused on candidate genes. Studies on hypertension pharmacogenomics aim to identify the genetic causes of response variations to antihypertensive drugs. Genetic association studies have identified single nucleotide polymorphisms affecting drug responses. To understand how genetic traits alter drug responses, computational screening of mutagenesis can be utilized to observe drug response variations at the protein level, which can help identify new inhibitors and drug targets to manage hypertension.

Conclusions::

Rational drug design facilitates the discovery and design of potent inhibitors. However, further research and clinical validation are required before novel inhibitors can be clinically used as antihypertensive therapies.

Gender Differences in Epidemiology, Pathophysiology, and Treatment of Hypertension

PURPOSE OF REVIEW

This review aims to examine gender differences in both the epidemiology and pathophysiology of hypertension and to explore gender peculiarities on the effects of antihypertensive agents in decreasing BP and CV events.

RECENT FINDINGS

Men and women differ in prevalence, awareness, and control rate of hypertension in an age-dependent manner. Studies suggest that sex hormones changes play a pivotal role in the pathophysiology of hypertension in postmenopausal women. Estrogens influence the vascular system inducing vasodilatation, inhibiting vascular remodeling processes, and modulating the renin-angiotensin aldosterone system and the sympathetic system. This leads to a protective effect on arterial stiffness during reproductive age that is dramatically reversed after menopause. Data on the efficacy of antihypertensive therapy between genders are conflicting, and the underrepresentation of aged women in large clinical trials could influence the results. Therefore, further clinical research is needed to uncover potential gender differences in hypertension to promote the development of a gender-oriented approach to antihypertensive treatment.