Sex Differences in Hypertension

Abstract

Hypertension is a complex disorder involving multiple organ systems and the primary modifiable risk factor for heart disease, which is the leading cause of death among both men and women in the United States. Although both men and women develop hypertension, distinct gender differences in the incidence and severity of hypertension are well established where men have a higher incidence of hypertension compared with women of the same age until the sixth decade of life.1,2 Despite gender differences in human hypertension, the treatment guidelines do not differ by gender.3 The first goal of this review is to examine the clinical data to determine whether this is appropriate, with the remainder of the review focused on basic science research implicating a role for the immune system in mediating sex differences in hypertension. The Institute of Medicine defined the term sex to classify subjects as men or women according to biology/genetics and the chromosomal complement of the individual. In contrast, the term gender includes socially constructed characteristics and the individual’s self-representation as male or female.4 In clinical studies, participants are asked to self-identify as men or women. For this reason, the term gender will be used throughout this review when referring to clinical studies, and sex will be used to refer to basic science studies examining males versus females based on phenotype. A recent study examined age-adjusted awareness, treatment, and blood pressure (BP) control rates among hypertensive men and women from 2003 to 2004 through 2011 to 2012.1 Awareness of hypertension increased in both men and women during this time period, with the greatest increase in awareness reported in women. Although women were less aware of their hypertension at the beginning of the study, they surpassed men’s awareness by the end of the study. One potential …