Gender Differences of Blood Pressure Control in Hypertensive Patients

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


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.


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


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