Gender Differences In Hypertension Control Widen With Advancing Age: MESA

Studies examining sex disparities in hypertension control among older adults do not account for differences in demographic factors and co-morbidities such as cardiovascular disease (CVD) that could influence blood pressure and hypertension management and control. To further explore, Dr HollyKramer and her team conducted a study to determine sex differences in hypertension control by age group in a diverse cohort of adults age 45–84 years at baseline followed for an average of 12 years.

In the Multi-Ethnic Study of Atherosclerosis (MESA) study, the researchers included a total of 3213 men and 3601 women from six communities in the U.S. during the years 2000–2002 with follow-up exams completed approximately every two years. At each exam, they measured the resting blood pressure (BP) in triplicate and averaged the last two values. Hypertension was determined as a BP ≥ 140/90 mmHg and/or use of antihypertensive medications. Hypertension control was determined as a BP < 140/90 mmHg and in separate analyses as < 130/90 mmHg.

They used generalized linear mixed-effects models with a binomial function to calculate the odds of hypertension control by age group (45–64,75–74, 75+) at a given exam and by sex while accounting for the intra-individual correlation, and adjustment for demographics, co-morbidities, smoking, alcohol use, education and site among participants with hypertension at any of the first five exams.

Key findings of the study were:

♦ Upon analysis, the researchers found that the average SBP was lower while the average DBP was higher among men vs women at each exam.

♦ They noted that the adjusted odds ratios of hypertension control among men vs women were

• 0.89 for age 45–64 years,
• 1.37 for age 65–74 years and,
• 2.08 for age 75+ years.

♦ When hypertension control was determined as < 130/80 mmHg, they noted that the adjusted odds of hypertension control among men vs women was

• 0.60 at age 45–64 years,
• 1.1 at age 65–74 years and
• 1.71 at age 75+ years.

The study findings suggest that after age 65 years, women are less likely than men to have controlled hypertension and sex differences in hypertension control were independent of obesity and diabetes.

The authors concluded, "After age 65 years, hypertension control rates are lower among women vs men and these sex differences widen with advancing age. More research is needed to determine the reasons for these age and sex differences in hypertension control. Quality improvement programs for hypertension control should include targeted interventions for older women to reduce their risk for cardiovascular disease and mortality."

For further information:

DOI: https://doi.org/10.1016/j.ajpc.2021.100230