Risk of heart disease in women: the role of hypertension
- Women in their early 40s with mild hypertension and high blood pressure may be twice as likely as those with normal blood pressure to have a heart attack or unstable angina in their 50s, according to a new study.
- While men are more likely than women to have high blood pressure in their early 40s, damage to the arteries seems to start with lower blood pressure in women.
- If confirmed, the results imply that there should be a lower threshold to start antihypertensive therapy in women.
In acute coronary syndromes, which include heart attacks and unstable angina, the blood flow that normally supplies the heart with oxygen is impaired.
Over the past decades, the overall incidence of acute coronary syndromes and the mortality rates associated with these events,
However, these improvements do not appear to include younger women.
In some countries, the number of young and middle-aged women hospitalized with acute coronary syndromes has actually increased.
There is some evidence that the side effects of increased blood pressure may be worse for women than for men, but it is uncertain whether this applies to younger women.
A new study has found that women in their early 40s with mildly elevated blood pressure – defined as stage 1 hypertension in the United States – are twice as likely to have a heart attack or unstable angina in the body. in their fifties, compared to women with normal blood. pressure.
The research, conducted by scientists at the University of Bergen, Norway, was published in the European Journal of Preventive Cardiology.
“The findings add to new evidence that high blood pressure has particularly adverse effects on the hearts of women,” said lead author of the study, Dr. Ester Kringeland.
Dr Kringeland said Medical News Today:
“All adult women need to know their blood pressure and have their blood pressure checked at least every 5 years. If women have other risk factors for heart disease, such as obesity, diabetes, autoimmune disease, [or] complications of pregnancy, or if they have parents with hypertension, their blood pressure should be measured every 1 to 2 years. “
Researchers investigated possible links between mildly elevated blood pressure in middle age and acute coronary syndromes in 6,381 women and 5,948 men participating in the Norwegian Hordaland Health Studies.
They defined stage 1 mild hypertension as systolic blood pressure of 130 to 139 millimeters of mercury (mm Hg) and diastolic blood pressure of 80 to 89 mm Hg.
At the start of the study, while the average age of participants was 41, 25% of women and 35% of men had stage 1 hypertension.
Over the next 16 years, 1.4% of women and 5.7% of men were diagnosed with a heart attack or unstable angina.
To isolate the risk from hypertension, the researchers adjusted the numbers to account for other risk factors, including diabetes, smoking, body mass index, cholesterol levels, and blood levels. physical activity.
After these adjustments, women with mild hypertension were 2.18 times more likely to have acute coronary syndrome than women who had normal blood pressure at the start of the study.
In men, there was no statistically significant association between blood pressure and acute coronary syndromes.
The study’s authors believe that gender-based differences in how small arteries respond to high blood pressure may explain women’s greater vulnerability to lower pressures.
Currently, US and EU clinical guidelines do not differentiate between men and women with respect to when clinicians should start treating hypertension.
MNT asked Dr Kringeland if it was now possible to lower the threshold for treating hypertension in women.
“Several studies have shown that women with hypertension are more likely to develop organ damage associated with high blood pressure and that hypertension is a greater risk factor for cardiovascular disease. [CVD] in women than in men, ”she replied.
“The gender-specific thresholds for [the] Defining hypertension would improve detection of CVD risk should be considered in future guidelines for hypertension management and CVD prevention, ”added Dr Kringeland.
However, she pointed out that there was a lack of evidence on whether treating mildly elevated blood pressure in women would reduce their risk of CVD.
Dr Donna Arnett, dean of the College of Public Health at the University of Kentucky, Lexington, and past president of the American Heart Association (AHA), said randomized clinical trials would be needed to accurately answer this question. .
She noted that the current study recorded who was receiving antihypertensive drugs at the start of the study, but not during the follow-up.
So there remains a possibility that the differences in these treatments between men and women with mild hypertension could explain the apparent differences in their risk for acute coronary syndromes, Dr Arnett said. MNT.
“Perhaps the most balanced message given the current state of the evidence is to aggressively screen and treat hypertension in women and men,” she concluded.
MNT asked Joanne Whitmore, senior cardiology nurse at the British Heart Foundation, to summarize what people can do to minimize their risk of developing hypertension.
“Simple everyday lifestyle choices can help lower your blood pressure. National guidelines [in the UK] recommend 150 minutes of moderate exercise each week… Recommendations also suggest following a Mediterranean-style diet, low in fat and salt. And if you smoke, quitting is the best thing you can do for your heart.