Gender Differences of Blood Pressure Control in Hypertensive Patients

H.D. Radchenko, T.H Salascheva, Yu.M. Sirenko, L.O. Mushtenko

Abstract


The objective of our study was to compare blood pressure control in wide Ukrainian population of hypertensive female and male patients and to define the factors associated with failure of blood pressure control during three-month antihypertensive therapy, depending on gender.
The study included patients (mean age 58.90 ± 0.24 years) with hypertension (n = 9,821). All patients depending on gender were divided into two groups: the first — 5,944 women, the second — 3,877 men. Doctors (n = 531) in its sole discretion administered to patients with hypertension antihypertensive drugs in doses that they see fit to prescribe. The effectiveness of treatment has been controlled at 4 visits within 3 months. During a visit, patients underwent measurement of office blood pressure, electrocardiography, evaluation of adherence to treatment using standard questionnaire, evaluation of cardiovascular risk and surveys according to the questionnaire worked out by the authors of the research. Multifactorial regression analysis was used to identify independent predictors of lack of treatment efficacy.
During the study, hypertension in women was associated with a higher incidence than in men of such complications as heart failure (48.4 vs. 45.8 %, P = 0.02) and stroke (17.8 vs. 15.8 % p = 0.02), comorbidities (diabetes mellitus — 15.2 vs. 12.1 %, P < 0.001, kidney disease — 23 vs. 20.4 %, P = 0.005) and risk factors (obesity — 37.1 vs. 21 %, P < 0.001, family history — 65.6 vs. 63.3 %, P = 0.02, older age — 60.10 ± 0.23 years vs. 58.5 ± 0.3 years, P < 0.001, high systolic blood pressure — 166.40 ± 0.24 mmHg vs. 165.20 ± ± 0.27 mmHg, P = 0.001). Men more often had myocardial infarction in past medical history (15.6 vs. 6.2 %, P < 0.001). Hypertensive males more often had bad habits (smoking, alcohol and salt abuse). However, additional physical activity was significantly in most male patients (57.2 vs. 47.7 %, P < 0.001). At baseline, only 23.6 % of patients in the first group and 20.9 % in the second group (P < 0.01) had high adherence to treatment. Against the background of therapy, there was a significant improvement of patients’ adherence to treatment in both groups: the proportion of patients with low adherence significantly reduced and the proportion with high and moderate adherence increased. However, at the end of the study more men than women were characterized as those with low adherence — 27.1 vs. 31.4 % (P < 0.001). In females, control of hypertension on the background of a three-month antihypertensive treatment was worse than in men — 50.6 vs. 58.3 % (P < 0.001). Common to both sexes factors independently and significantly associated with poorer control of blood pressure were age, initial levels of systolic and diastolic blood pressure, poor adherence to treatment both at the beginning and at the end of the study, the absence of status «working». Unlike men, in women greater body mass index increased the likelihood of failure to achieve target blood pressure (β = 1.025, P = 0.003), and high intake of fresh vegetables, on the contrary, reduced it (β = 0.63, P = 0.002). In men, additional physical activity reduced the likelihood of inadequate control of hypertension (β = 0.78, P = 0.02).
Thus, blood pressure control in our study was the best in men, in spite of better adherence to treatment in women. Due to the fact that different factors in men and women are associated with lack of effectiveness of therapy, measures to improve blood pressure control in hypertensive patients should be different for men and women. Along with improved adherence to treatment in females, it is necessary to modify lifestyle for weight loss and to increase consumption of fresh vegetables. In men, great attention should be paid to increasing physical activity and adherence to treatment. Patients of both sexes with higher levels of blood pressure, older patients and those who do not work, should be allocated to the group of more closely monitoring.


Keywords


hypertension; men; women; blood pressure control; antihypertensive therapy

References


Горбась І.М. Контроль артеріальної гіпертензії серед населення: стан проблеми за даними епідеміологічних досліджень // Укр. кардіол. журнал. — 2007. — № 2. — С. 21-26.

Коваленко В.М., Лутай М.І., Свіщенко Є.П., Сіренко Ю.М., Смирнова І.П. Рекомендації Українського товариства кардіологів з профілактики та лікування артеріальної гіпертензії. — К.: Віпол, 2004. — 84 с.

Настанова та клінічний протокол надання медичної допомоги «Артеріальна гіпертензія». Наказ МОЗ України № 384 від 24.05.2012. — К., 2012. — 107 с.

Сіренко Ю., Радченко Г., Марцовенко І., від імені учасників дослідження. Результати тримісячного спостереження за лікуванням пацієнтів з артеріальною гіпертензією лікарями загальної практики в Україні // Артеріальна гіпертензія. — 2009. — № 4. — С. 3-14.

2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // Journal of Hypertension. — 2013. — Vol. 31. — P. 1281-1357.

Banegas J., Segura J., Sierra A. et al. Gender Differences in Office and Ambulatory Control of Hypertension // The American Journal of Medicine. — 2008. — Vol. 121. —P. 1078-1084.

Chou A.F., Scholle S.H., Weisman C.S., Bierman A.S., Correa-de-Araujo R., Mosca L. Gender disparities in the quality of cardiovascular disease care in private managed care plans // Womens Health Issues. — 2007. — Vol. 17(3). — P. 120-130.

Chou A.F., Wong L., Weisman C.S., Chan S., Bierman A.S., Correa-de-Araujo R., Scholle S.H. Gender disparities in cardiovascular disease care among commercial and medicare managed care plans // Womens Health Issues. — 2007. — Vol. 17. — P. 139-149.

Cutler J.A., Sorlie P.D., Wolz M., Thom T., Fields L.E., Roccella E.J. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004 // Hypertension. — 2008. — Vol. 818. — P. 827-852.

Daugherty S.L., Masoudi F., Ellis J. et al. Age-dependent gender differences in hypertension management // Journal of Hypertension. — 2011. — Vol. 29. — P. 1-7.

Deeks A., Lombard C., Michelmore J., Teede H. The efects of gender and age on health related behaviors // BMC Public Health. — 2009. — Vol. 9. — P. 213.

Gee M.E., Bienek A., McAlister F.A., Robitaille C., Jofres M., Tremblay M.S. et al. Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension // Can. J. Cardiol. — 2012. — Vol. 28(3). — P. 375-382.

Girerd X., Fourcade J., Brillet G. et al. The compliance evaluation test: a validated tool for detection of nonadherence among hypertensive treated patients // J. Hypertens. — 2001. — Vol. 19. — P. 74 S.

Girerd X., Hanon O., Anagnostopoulos K. et al. Evaluation de l’observance du traitement antihypertenseur par un questionnaire: mise au point et utilization dans un service specialize // Presse Med. — 2001. — Vol. 30. — P. 1044-1048.

Gu Q., Burt V.L., Paulose-Ram R., Dillon C.F. Gender diferences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999–2004 // Am. J. Hypertens. — 2008. — Vol. 21(7). — P. 789-798.

Gu Q., Paulose-Ram R., Dillon C., Burt V. Antihypertensive medication use among US adults with hypertension // Circulation. — 2006. — Vol. 113. — P. 213-221.

Hicks L.S., Fairchild D.G., Horng M.S., Orav E.J., Bates D.W., Ayanian J.Z. Determinants of JNC VI guideline adherence, intensity of drug therapy, and blood pressure control by race and ethnicity // Hypertension. — 2004. — Vol. 44. — P. 429-434.

Keyhani S., Scobie J.V., Hebert P.L., McLaughlin M.A. Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits // Hypertension. — 2008. — Vol. 51. — P. 1149-1155.

Lawes C.M.M., Hoorn S.V., Rodgers A. Global burden of blood-pressure related disease // Lancet. — 2001. — Vol. 371. — P. 1513-1518.

Majernick T.G., Zacker C., Madden N.A., Belletti D.A., Arcona S. Correlates of hypertension control in a primary care setting // Am. J. Hypertens. — 2004. — Vol. 17. — P. 915-920.

Ong K., Tso A., Lam K., Cheung B. Gender Difference in Blood Pressure Control and Cardiovascular Risk Factors in Americans With Diagnosed Hypertension // Hypertension. — 2008. — Vol. 51. — P. 1142-1148.

Ornstein S., Nietert P., Dickerson L. Hypertension management and control in primary care: a study of 20 practices in 14 states // Pharmacotherapy. — 2004. — Vol. 4. — P. 500-507.

Os I., Oparil S., Gerdts E., Hoieggen A. Essential hypertension in women // Blood Press. — 2004. — Vol. 13(5). — P. 272-278.

Ostchega Y., Hughes J.P., Wright J.D., McDowell M.A., Louis T. Are demographic characteristics, health care access and utilization, and comorbid conditions associated with hypertension among US adults? // Am. J. Hypertens. — 2008. — Vol. 21(2). — P. 159-165.

Ostchega Y., Dillon C.F., Hughes J.P., Carroll M., Yoon S. Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults:data from the National Health and Nutrition Examination Survey 1988 to 2004 // J. Am. Geriatr. Soc. — 2007. — Vol. 55. — P. 1056-1065.

Sang Hui Chu, Ji Won Baek, Eun Sook Kim et al. Gender Diferences in Hypertension Control Among Older Korean Adults: Korean Social Life, Health, and Aging Project // J. Prev. Med. Public Health. — 2015. — Vol. 48. — P. 38-47.

Stockwell D.H., Madhavan S., Cohen H., Gibson G., Alderman M.H. The determinants of hypertension awareness, treatment, and control in an insured population // Am. J. Public Health. — 1994. — Vol. 84. — P. 1768-1774.

Svetkey L., George L., Tyroler H. et al. Effects of Gender and Ethnic Group on Blood Pressure Control in the Elderly // Am. J. Hypertens. — 1996. — Vol. 9(6). — P. 529-535.

Thoenes M., Neuberger H., Volpe M. et al. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective // J. Human Hypertension. — 2009. doi: 10.1038/jhh.2009.76

Yu H.T., Kim K.J., Bang W.D., Oh C.M., Jang J.Y., Cho S.S. et al. Gender-based diferences in the management and prognosis of acute coronary syndrome in Korea // Yonsei Med. J. — 2011. — Vol. 52(4). — P. 562-568.

Yusuf S., Hawken S., Ounpuu S., Dans T., Avezum A., Lanas F. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart study): case-control study // Lancet. — 2004. — Vol. 364. — P. 937-952.




DOI: https://doi.org/10.22141/2224-1485.2.40.2015.80475

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 HYPERTENSION

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru