Blood Pressure Control In Women Research Articles

The “Preeclampsia and Hypertension Target Treatment” study: a multicenter prospective study to evaluate the effectiveness of the antihypertensive therapy based on maternal hemodynamic findings

Despite major advances in the pharmacologic treatment of hypertension in the nonpregnant population, treatments for hypertension in pregnancy have remained largely unchanged over the years. There is recent evidence that a more adequate control of maternal blood pressure is achieved when the first given antihypertensive drug is able to correct the underlying hemodynamic disorder of the mother besides normalizing the blood pressure values. This study aimed to compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy following the baseline hemodynamic findings. This was a prospective multicenter study that included a population of women with de novo diagnosis of hypertensive disorders of pregnancy. A noninvasive assessment of the following maternal parameters was performed on hospital admission via Ultrasound Cardiac Output Monitor before any antihypertensive therapy was given: cardiac output, heart rate, systemic vascular resistance, and stroke volume. The clinician who prescribed the antihypertensive therapy was blinded to the hemodynamic evaluation and used as first-line treatment a vasodilator (nifedipine or alpha methyldopa) or a beta-blocker (labetalol) based on his preferences or on the local protocols. The first-line pharmacologic treatment was retrospectively considered hemodynamically appropriate in either of the following circumstances: (1) women with a hypodynamic profile (defined as low cardiac output [≤5 L/min] and/or high systemic vascular resistance [≥1300 dynes/second/cm2]) who were administered oral nifedipine or alpha methyldopa and (2) women with a hyperdynamic profile (defined as normal or high cardiac output [>5 L/min] and/or low systemic vascular resistances [<1300 dynes/second/cm2]) who were administered oral labetalol. The primary outcome of the study was to compare the occurrence of severe hypertension between women treated with a hemodynamically appropriate therapy and women treated with an inappropriate therapy. A total of 152 women with hypertensive disorders of pregnancy were included in the final analysis. Most women displayed a hypodynamic profile (114 [75.0%]) and received a hemodynamically appropriate treatment (116 [76.3%]). The occurrence of severe hypertension before delivery was significantly lower in the group receiving an appropriate therapy than in the group receiving an inappropriately treated (6.0% vs 19.4%, respectively; P=.02). Moreover, the number of women who achieved target values of blood pressure within 48 to 72 hours from the treatment start was higher in the group who received an appropriate treatment than in the group who received an inappropriate treatment (70.7% vs 50.0%, respectively; P=.02). In pregnant individuals with de novo hypertensive disorders of pregnancy, a lower occurrence of severe hypertension was observed when the first-line antihypertensive agent was tailored to the correct maternal hemodynamic profile.

Testosterone effects on autonomic function in women with androgen excess polycystic ovary syndrome

Women with androgen excess-polycystic ovarian syndrome (AE-PCOS) present with increased blood pressure (BP) and impaired cardiovascular autonomic control. We tested the hypothesis that androgens play an obesity-independent role in impaired baroreflex (BR) sensitivity and renin-angiotensin system (RAS) control of BP in women with AE-PCOS. We measured the sympathetic baroreflex (sBR) and cardiovagal baroreflex (cvBR) with the modified Oxford procedure, and integrated baroreflex (iBR) and the RAS response to lower body negative pressure (LBNP) in obese, insulin resistant (IR) women with AE-PCOS (n=9; age=23±4 y; BMI=36.3±6.4 kg/m2) and obese, IR controls (CTL) (n=7; age=29±7 y; BMI=34.9±6.8 kg/m2). Studies were conducted at baseline (BSL), after 4 days of reproductive hormone suppression with a gonadotropin-releasing hormone antagonist (ANT, 250 μg/day), and after 4 days of ANT+testosterone (ANT+T, 5 mg/day). At BSL, AE-PCOS and CTL had similar systolic BP (137±14 vs.133±14 mmHg, respectively) and diastolic BP (76±8 vs.63±12 mmHg, respectively). Resting MSNA burst incidence was lower (10.3±3.1 vs. 14.3±4.4 bursts-1×100 hb, P=0.04), but total MSNA activity was greater in AE-PCOS compared to CTL (249±112 vs. 156±44 bursts/min, respectively, P=0.04). Hormone intervention did not impact resting MSNA or BP in either group. In the AE-PCOS group, sBR gain increased during modified Oxford with ANT suppression of T, but sBR gain was restored to BSL when T was reintroduced (-0.48±0.15, -0.63±0.19, and -0.50±0.15 bursts -1 ·100 hb·mmHg -1 for BSL, ANT and ANT+T, respectively, P=0.01). Hormone interventions did not impact sBR gain in CTL (-0.48±0.06, -0.47±0.10, and -0.46±0.09 bursts -1 ·100 hb·mmHg -1 for BSL, ANT and ANT+T, respectively). iBR gain for AE-PCOS and CTL was similar at BSL (1.4±0.9 vs. 1.0±1.3 FVR unit/mmHg, respectively). In AE-PCOS, T suppression increased iBR gain, which was restored to BSL with ANT+T (4.3±6.5 vs.1.5±0.8 FVR unit/mmHg for ANT and ANT+T respectively, P&lt;0.04), with no effect in CTL (1.9 ± 3.0 vs. 0.7±0.9 FVR unit/mmHg for ANT and ANT+T, respectively). cvBR gain was unaffected by group or treatment. Serum aldosterone was greater in AE-PCOS vs CTL (136.5±60.2 vs. 75.7±41.4 pg/ml, respectively, P&lt;0.04), but unaffected by hormone intervention. Serum angiotensin converting enzyme (S [ACE] ) in AE-PCOS was greater compared to CTL at BSL (101.9±93.4 vs. 38.2 ±14.7 pg/ml, respectively, P&lt;0.04). In AE-PCOS, S [ACE] was reduced by ANT (77.7 ±76.5 and 40.6±10.6 μg/L for ANT vs. ANT+T, respectively, P&lt;0.04), but hormone intervention did not impact CTL (43.4±27.3 and 40.6±1 μg/L for ANT vs. ANT+T, respectively, P&lt;0.04). These data suggest the milieu of AE-PCOS increases susceptibility to T driven autonomic perturbations as T elevation had differential effects in AE-PCOS vs. CTL. Our data indicate a powerful relationship among elevated androgens, autonomic function, and the kidney.NIH HL135089/P20GM 121334 National Institutes of Health, NHLBI HL135089 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Circulating human sPRR increased blood pressure in female mice fed a low‐fat diet

Essential hypertension and obesity‐hypertension have been associated with elevated plasma soluble prorenin receptor (sPRR) in men. Additionally, our laboratory previously found that the infusion of mouse sPRR elevates systolic blood pressure (SBP) in high‐fat (HF) fed male mice through activation of the sympathetic nervous system but did not elevate SBP in HF‐fed female mice. Interestingly, the infusion of mouse sPRR increased renal and hepatic angiotensinogen (AGT) and plasma renin concentration in female mice fed a standard diet. However, the mechanistic role of sPRR on the renin angiotensin system (RAS) to regulate blood pressure in lean female mice remains to be investigated. Moreover, there is critical gap concerning the functional role of human sPRR on blood pressure in women. Therefore, in the present study, we aim to determine whether human sPRR participates to blood pressure control in lean female mice.A transgenic mouse model expressing the human form of the soluble prorenin receptor (HsPRR‐Myc‐tag) was developed. Human sPRR‐transgenic female mice were bred with male mice expressing Alb/Cre recombinase to generate mice selectively expressing human sPRR (Alb‐HsPRR) in the liver and control littermates (CTL). Control and Alb‐HsPRR female mice were fed a LF‐diet for 8 months (n=11/groups). Body weight was assessed weekly and body composition was examined monthly. Blood pressure was assessed by radiotelemetry. Human sPRR‐Myc‐tag was detected in the liver of Alb‐HsPRR female mice and plasma sPRR levels increased by 50‐fold (CTL: 3.6±0.5 ng/ml, Alb‐HsPRR: 190.5±24.4 ng/ml; P&lt;0.05), which validated the humanized mouse model.Elevated circulating human sPRR did not change body weight (CTL: 22.2±0.4g, Alb‐HsPRR: 23.0±0.3g) or fat mass (CTL: 2.5±0.2, Alb‐HsPRR:3.1±0.2g). Liver‐derived human sPRR significantly elevated SBP in Alb‐HsPRR compared to control female mice (Night SBP: CTL, 130.5±1.2 mmHg; Alb‐HsPRR, 135.9±2 mmHg; P&lt;0.05) and acute injection of Angiotensin II exacerbated the SBP elevation. Interestingly, the decrease in blood pressure mediated by Losartan was not different between Alb‐HsPRR and control female mice (Night □SBP: CTL, ‐13.1±2.2 mmHg; Alb‐HsPRR, ‐14.8±2.7 mmHg; P&gt;0.05). Plasma AGT and renin activity were similar between Alb‐HsPRR and control littermate female mice suggesting that the elevation of SBP was not mediated by the circulating renin angiotensin system. Therefore, whether the sympathetic nervous system is involved in human sPRR‐mediated increase of SBP remains to be examined. Altogether, these results support an important role of circulating human sPRR in blood pressure control in women.

Changes in ophthalmic artery Doppler during acute blood-pressure control in hypertensive pregnant women.

To examine the changes in ophthalmic artery Doppler indices and their association with changes in mean arterial blood pressure (MAP) and systolic (SBP) and diastolic (DBP) blood pressure, following acute antihypertensive treatment in women with hypertensive disorders of pregnancy presenting with high blood pressure. This was a prospective cohort study of 31 pregnant women presenting at 30 + 0 to 39 + 6 weeks' gestation for management of their hypertension. Paired maternal blood-pressure and ophthalmic-artery-Doppler measurements were performed prior to and at 30 min and 60 min after starting antihypertensive medication. In patients who did not achieve blood-pressure control (i.e. when blood pressure was < 140/90 mmHg) by 60 min, paired readings were continued up to 120 min. If blood-pressure control was still not achieved at that point, patients were admitted to hospital. Univariate linear regression was performed to determine the association of ophthalmic artery peak systolic velocity (PSV) ratio with SBP, DBP and MAP before treatment and after blood-pressure control. The longitudinal changes in MAP, SBP, DBP and PSV ratio from pretreatment to 30 min and 60 min after commencement of antihypertensives were examined by repeated measure, multilevel, linear mixed-effects analysis. Antihypertensive treatment was associated with a decrease in SBP, DBP, MAP and PSV ratio. At 60 min following antihypertensive treatment, the decrease in SBP, DBP, MAP and PSV ratio was 12.1 mmHg (95% CI, 9.0-15.1 mmHg; P < 0.0001), 9.1 mmHg (95% CI, 6.5-11.5 mmHg; P < 0.0001), 10.0 mmHg (95% CI, 7.6-12.4 mmHg; P < 0.0001) and 0.07 (95% CI, 0.03-0.11 mmHg; P < 0.001), respectively. From the total cohort, 20 (64.5%) women had achieved blood-pressure control at 60 min and another seven (22.6%) by 120 min from commencement of antihypertensive treatment. Four (12.9%) women did not achieve blood-pressure control during this period and were admitted to hospital. The relationship between PSV ratio and SBP, DBP and MAP was assessed before treatment (n = 31) and at the point of blood-pressure control in women in whom this was achieved by 120 min (n = 27). Prior to treatment, there was a significant association between PSV ratio and MAP (P < 0.0001, R2 = 0.39). This was primarily due to the association of PSV ratio with DBP (P < 0.0001, R2 = 0.39) and less so due to its association with SBP (P = 0.02, R2 = 0.16). At the point of achieving blood-pressure control, there was no significant association between PSV ratio and MAP (P = 0.7), DBP (P = 0.5) or SBP (P = 0.7). Acute blood-pressure control in pregnancy is associated with a concomitant reduction in blood pressure and ophthalmic artery PSV ratio. In hypertensive pregnant women, there is a significant association of PSV ratio with MAP, SBP and DBP, which disappears after blood pressure is reduced to < 140/90 mmHg following antihypertensive treatment. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Blood pressure control in women with chronic hypertension and perinatal outcome

Patients with chronic hypertension (CHTN) are at increased risk of adverse outcomes: small for gestational age (SGA), superimposed preeclampsia (SIP) with or without severe features, and preterm birth (PTB). These outcomes might be modified by blood pressure control in pregnancy. To evaluate the incidence of SGA, PTB, and SIP with or without severe features based on blood pressure control.

Effect of calcium channel blocker on labor curve in pregnant women with chronic hypertension

Though calcium channel blocker (CCB) is used as a tocolytic for preterm labor, it is also used for blood pressure control in women with chronic hypertension. We sought to examine the labor curves of women with chronic hypertension according to the use of CCB during labor.

Abstract 47: Circulating Human Sprr Increased Blood Pressure In Female Mice Fed A Low-fat Diet

Elevated plasma soluble prorenin receptor (sPRR) is associated with essential hypertension and obesity-hypertension in men. Additionally, our laboratory previously found that the infusion of mouse sPRR elevates systolic blood pressure (SBP) in high-fat (HF) fed male mice through activation of the sympathetic nervous system but did not elevate SBP in HF-fed female mice. Interestingly, mouse sPRR infusion increased renal and hepatic angiotensinogen (AGT) and plasma renin concentration in female mice fed a low-fat diet. However, whether sPRR-activates the renin angiotensin system (RAS) and increases blood pressure in low-fat fed female mice remains to be investigated. Additionally, little is known concerning the influence of human sPRR on blood pressure in women. Therefore, we developed a humanized mouse model with high circulating human sPRR. Human sPRR-Myc-tag transgenic mice were bred with mice expressing Alb/Cre recombinase to induce human sPRR release in the circulation. Control and Alb-HsPRR female mice were fed a LF-diet for 8 months (n=11/groups). Body weight and body composition were examined and blood pressure assessed by radiotelemetry. Human sPRR-Myc-tag was detected in the liver of Alb-HsPRR female mice and plasma sPRR levels increased by 50-fold (CTL: 3.6±0.5 ng/ml, HsPRR:190.5±24.4 ng/ml; P&lt;0.05), which validated the humanized mouse model. Elevated circulating human sPRR did not change body weight (CTL: 22.2±0.37, HsPRR: 23.0±0.32 g) or fat mass (CTL: 2.5±0.2, HsPRR: 3.1±0.2 g). Liver-derived human sPRR significantly elevated SBP in Alb-HsPRR compared to control female mice (Night SBP: CTL: 130.5±1.2 mmHg; Alb-HsPRR: 135.9±2 mmHg; P&lt;0.05) and acute injection of AngII exacerbated SBP elevation. Interestingly, the decrease in blood pressure mediated by losartan was not different between Alb-HsPRR and control female mice (Night ΔSBP: CTL: -13.11±2.2 mmHg; Alb-HsPRR: -14.8±2.7 mmHg; P&gt;0.05). Plasma AGT and renin activity were similar between Alb-HsPRR and control female mice. Therefore, whether the local RAS or the sympathetic nervous system are involved in human sPRR-mediated increase of SBP remains to be examined. Altogether, our results suggest an important role of circulating human sPRR in blood pressure control in women.

Furosemide for Accelerated Recovery of Blood Pressure Postpartum in women with a hypertensive disorder of pregnancy: A Randomized Controlled Trial.

[Figure: see text].

Effect of Ibuprofen Versus Acetaminophen on Postpartum Hypertension in Preeclampsia With Severe Features: A Double-masked, Randomized Controlled Trial

(Am J Obstet Gynecol. 2018;218:616.e1–e8) Hypertensive disorders of pregnancy contribute to maternal morbidity and mortality. Women with hypertension are at increased risk for cesarean delivery. The American College of Obstetricians and Gynecologists suggests avoiding the use of nonsteroidal antiinflammatory drugs (NSAIDS) in women with preeclampsia as they have been shown to increase blood pressure in nonpregnant adults. The purpose of this study was to evaluate the effect of ibuprofen compared with acetminophen on blood pressure control in the postpartum period in women diagnosed with preeclampsia with severe features. They hypothesized that NSAIDs would adversely affect postpartum blood pressure control in women with preeclampsia with severe features.

Aging Alters the Relative Contributions of the Sympathetic and Parasympathetic Nervous System to Blood Pressure Control in Women.

Autonomic support of blood pressure increases with age in humans. Large differences exist in the dose of trimethaphan (TMP) required for ganglionic blockade in young and older women. We asked whether differences in the dose of TMP required to achieve ganglionic blockade are because of differences in the relative contributions of the sympathetic and parasympathetic nervous system in control of blood pressure with age. Muscle sympathetic nerve activity (microneurography, peroneal nerve), heart rate (HR), and blood pressure were recorded before and during incremental doses of TMP camsylate until ganglionic blockade was achieved (absence of muscle sympathetic nerve activity and <5-bpm increase in HR during a valsalva maneuver; final TMP dose, 1-7 mg/min). HR variability was analyzed from the ECG waveform (WinCPRS). The dose of TMP required to achieve ganglionic blockade is positively related to basal HR variability, where women with high HR variability require a higher dose of TMP to achieve ganglionic blockade. In contrast, baseline muscle sympathetic nerve activity is inversely related with the dose of TMP required to achieve ganglionic blockade, such that women with high basal muscle sympathetic nerve activity required a lower dose of TMP. As such, the change in HR with ganglionic blockade was positively related, and the change in mean arterial pressure was inversely related, with the dose of TMP required to achieve ganglionic blockade. These data suggest loss of parasympathetic tone and increased sympathetic tone with aging contribute to the increase in blood pressure with age in women and dictate the dose of TMP that is necessary to achieve ganglionic blockade.

¿Cuál es el efecto de las nuevas definiciones de hipertensión arterial en el adulto sobre el diagnóstico y manejo de esta condición en la gestante y de los trastornos hipertensivos del embarazo?

El American College of Cardiology (ACC) y el American Heart Association (AHA) publicaron nuevas guías para la prevención, detección, prevención, evaluación y manejo de la hipertensión en el adulto en el 2017 basadas en una revisión comprensiva sistemática de la literatura por parte de un comité científico de expertos. En las definiciones del ACC/AHA, hipertensión arterial se divide en estadio 1 (presión arterial sistólica (PAS) 130-139 mmHg y presión arterial diastólica (PAD) 80-89 mmHg) y estadio 2 (PAS ≥ 140 mmHg y PAD ≥ 90 mmHg). Los objetivos primarios del ACA/AHA son la detección temprana de la enfermedad, evaluación rápida, manejo oportuno y prevención de la enfermedad cardiovascular. Con estos cambios, se estima un aumento del 15 a 20% de la prevalencia de la hipertensión en los Estados Unidos (EE. UU.) en los próximos años. También, se espera un aumento considerable del número de gestantes que van a concebir con el diagnóstico de hipertensión arterial. No se han publicado aun actualizaciones en la clasificación de hipertensión pregestacional y gestacional por parte de organizaciones profesionales como el American College of Obstetricians &amp; Gynecologists (ACOG), pero podrían ser publicadas próximamente. Mientras tanto, nosotros debemos continuar siguiendo las guías clínicas actuales de manejo de estas condiciones. En los EE. UU. se recomienda seguir las guías clínicas publicadas por el ACOG en el 2013, las cuales especifican la clasificación, predicción y manejo de la hipertensión durante el embarazo. En estas guías, hipertensión se define como una presión arterial (PA) ≥ 140/90 mmHg. Según el ACOG, el objetivo en el manejo médico de la hipertensión es mantener la presión arterial (PA) en &lt;160/105 mmHg. Se recomienda el control estricto de la PA &lt; 140/90 mmHg solamente en pacientes con hipertensión, comorbilidades como diabetes pregestacional y daño de órgano blanco. Para las otras pacientes, no se recomienda control estricto de la hipertensión, debido a la falta de evidencia científica de los beneficios y los posibles efectos negativos sobre la perfusión placentaria y el crecimiento fetal. Se espera que el estudio clínico pragmático aleatorizado multicéntrico que se está realizando en los EE. UU. (ClinicalTrials.gov Identifier: NCT02299414) suministre información acerca del mejoramiento de los resultados maternos y perinatales asociados con el control estricto de la PA en pacientes con hipertensión crónica. Por ahora, los especialistas en obstetricia deben continuar siguiendo las recomendaciones del ACOG o de otras organizaciones profesionales y estar atentos a nuevos comunicados por parte de estas organizaciones o expertos en el tema.

Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial

Nonsteroidal antiinflammatory drug use has been shown to increase blood pressure in nonpregnant adults. Because of this, the American College of Obstetricians and Gynecologists suggests avoiding their use in women with postpartum hypertension; however, evidence to support this recommendation is lacking. Our goal was to test the hypothesis that nonsteroidal antiinflammatory drugs, such as ibuprofen, adversely affect postpartum blood pressure control in women with preeclampsia with severe features. At delivery, we randomized women with preeclampsia with severe features to receive around-the-clock oral dosing with either 600 mg of ibuprofen or 650 mg of acetaminophen every 6 hours. Dosing began within 6 hours after delivery and continued until discharge, with opioid analgesics available as needed for breakthrough pain. Study drugs were encapsulated in identical capsules such that patients, nurses, and physicians were masked to study allocation. Exclusion criteria were serum aspartate aminotransferase or alanine aminotransferase >200 mg/dL, serum creatinine >1.0 mg/dL, infectious hepatitis, gastroesophageal reflux disease, age <18 years, or current incarceration. Our primary outcome was the duration of severe-range hypertension, defined as the time (in hours) from delivery to the last blood pressure ≥160/110 mm Hg. Secondary outcomes were time from delivery to last blood pressure ≥150/100 mm Hg, mean arterial pressure, need for antihypertensive medication at discharge, prolongation of hospital stay for blood pressure control, postpartum use of short-acting antihypertensives for acute blood pressure control, and opioid use for breakthrough pain. We analyzed all outcome data according to intention-to-treat principles. We assessed 154 women for eligibility, of whom 100 met entry criteria, agreed to participate, and were randomized to receive postpartum ibuprofen or acetaminophen for first-line pain control. Seven patients crossed over or did not receive their allocated study drug, and 93 completed the study protocol in their assigned groups. We found no differences in baseline characteristics between groups, including mode of delivery, body mass index, parity, race, chronic hypertension, and maximum blood pressure prior to delivery. We did not find a difference in the duration of severe-range hypertension in the ibuprofen vs acetaminophen groups (35.3 vs 38.0 hours, P= .30). There were no differences between groups in the secondary outcome measures of time from delivery to last blood pressure ≥150/100 mm Hg, postpartum mean arterial pressure, maximum postpartum systolic or diastolic blood pressures, any postpartum blood pressure ≥160/110 mm Hg, short-acting antihypertensive use for acute blood pressure control, length of postpartum stay, need to extend postpartum stay for blood pressure control, antihypertensive use at discharge, or opioid use for inadequate pain control. In a subgroup analysis of patients who experienced severe-range hypertension, the mean time to blood pressure control in the acetaminophen group was 68.4 hours and ibuprofen group was 56.7 hours (P= .26). At 6 weeks postpartum, there were no differences between groups in the rates of obstetric triage visits, hospital readmissions, continued opioid use, or continued antihypertensive use. The first-line use of ibuprofen rather than acetaminophen for postpartum pain did not lengthen the duration of severe-range hypertension in women with preeclampsia with severe features.

PP.06.26] EFFECT OF STANDARDIZED ALGORITHMIC TREATMENT ON HOME BLOOD PRESSURE VARIABILITY

Objective: Home blood pressure (BP) variability (HBPV) is a significant predictor of cardiovascular events, but gender differences in the drug treatment effect on HBPV remains uncertain. Our purpose was to compare the effect of 6 month (M) standardized algorithmic treatment on HBPV in men and women <75 years with uncomplicated hypertension (UH). Design and method: To PERFECT-BP prospective observational study (ISRCTN75706523) subanalysis were included 209 newly diagnosed (14,4%) or treated but uncontrolled (BP<200/120 mmHg) UH patients (pts) aged 59 ± 9,5, 89 (42,6%) male, 120 (57,4%) female, 27 (12,9%) diabetics. Home BP monitoring (HBPM) was performed by standardized automatic Microlife BP3AG1 device with individually selected cuff, thrice in the morning and in the evening, for 7 consecutive days before each visit at day 7, M1, 2, 3, 6. At visit 1 pts were prescribed or switched to perindopril/amlodipine fixed-dose combination (FDC). Step 2 was FDC uptitration, step 3 – indapamide SR, step 4 – spironolactone, step 5 – moxonidine or doxazosin. HBPV was defined as the standard deviation (SD) and the coefficient of variation (CV) of the daily BP average of 6 readings of 7 consecutive days (42 BP readings). Results: By 6 M, target office BP was attained in 71 (79,8%) men vs 103 (85,8%; p > 0,05) women, home BP<135/85 mmHg – in 51 (57,3%) vs 87 (72,5%, p < 0,03) and both – in 47 (52,8%) vs 80 (66,7%, p < 0,05). Home systolic BP (SBP) in men and women reduced from 148,8 ± 17,9 and 145,7 ± 16,8 mmHg (p < 0,05) to 134,7 ± 12,2 and 129,4 ± 10,8 mmHg (p < 0,01), diastolic (DBP) – from 87,3 ± 10,5 and 83,6,5 ± 9,8 mmHg (p < 0,05) to 79,5 ± 7,9 and 77,4 ± 5,7 mmHg (p > 0,05); home SBP SD – from 8,2 ± 3,5 and 8,8 ± 4,6 mmHg (p > 0,05) to 4,9 ± 2,4 and 6,2 ± 3,7 mmHg (p < 0,001), SBP CV – from 5,2 ± 2,2 and 5,7 ± 2,6% (p > 0,05) to 3,8 ± 1,5 and 4,5 ± 2% (p < 0,01); home DBP SD – from 5,7 ± 3 and 6,1 ± 3 mmHg (p > 0,05) to 3,6 ± 2 and 4,9 ± 3 mmHg (p < 0,01), CV – from 6,1 ± 3 and 6,9 ± 3% (p > 0,05) to 4,7 ± 2 and 5,9 ± 3% (p < 0,01). Conclusions: Better home BP control in women compared to men is associated with higher rates of home SBP and DBP variability after 6 M of standardized algorithmic treatment based on FDC in real life setting.

The benefits/risks of treatment of non-severe hypertension in pregnancy and choice of drug remain unanswered.

Pregnancies complicated by non-severe hypertension are at increased risk of multiple maternal and fetal complications, such as pre-eclampsia and severe hypertension. The optimal target blood pressure achieved during pregnancy must aim for the safety of the mother and delivery of a live infant, while minimising prolonged or intensive neonatal care. Thus, one must balance the potential immediate maternal benefits against possible short- and long-term risks to the fetus and infant from the effects that lowering blood pressure have on fetal growth. Tight blood pressure control results in more women requiring antihypertensive drugs but less women developing severe hypertension, and tight blood pressure control may lead to more infants born small for gestational age (SGA). The Control of Hypertension in Pregnancy Study (CHIPS) evaluated the benefits and risks of tight versus less tight blood pressure control in women with non-severe chronic (CHTN) or gestational hypertension (GHTN) enrolled at 14–33 weeks of gestation. The primary outcome was pregnancy loss or high-level neonatal care for longer than 48 hours. Secondary outcomes were a composite of adverse maternal outcomes and rates of severe hypertension, pre-eclampsia, and SGA. There were no differences between groups in rates of either primary or secondary outcomes, pre-eclampsia, or SGA; however, severe hypertension was higher with less tight control (40.6 versus 27.5%; adjusted odds ratio, aOR 1.8; 95% confidence interval, 95% CI 1.34–2.38). Similar findings were found with CHTN, with the rate of severe hypertension being lower under tight control (43.1 versus 26.4%; aOR 0.47, 95% CI 0.34–0.65). In contrast, CHTN in the tight-control group had higher rates of SGA (19.7 versus 13.9%; OR 1.5, 95% CI 1.0–2.3). The objective of the secondary analysis from CHIPS was to determine whether the differences in outcomes between less tight and tight control of blood pressure depended on the use of labetalol or methyldopa. Analysis was performed both at and after randomisation. Mixed-effects logistic regression was used to assess the dependence of treatment on antihypertensive therapy after randomisation (labetalol or methyldopa), adjusting for factors that might influence the outcome. The analysis revealed that outcomes were not dependent on the use of labetalol or methyldopa. Based on the results of this analysis, the authors suggest that clinicians can use either agent to treat non-severe hypertension in women with CHTN or GHTN. The results of CHIPS and this secondary analysis warrant several comments. First, the statement that less tight control in CHIPS was associated with no perinatal benefit is questionable, as the trial was not powered to evaluate the effects of tight blood pressure control on the rate of SGA infants. Indeed, the rate of SGA was significantly higher with tight control in women with CHTN. Second, in women with GHTN, only 45 received labetalol and 21 received methyldopa (12 with less tight control and nine with tight control) at randomisation, and only 37 women (12 with less tight control and 25 with tight control) received methyldopa after randomisation. Thus, this analysis did not have adequate power to answer the question of whether the results in women with GHTN were modified by methyldopa or labetalol. Other studies have found labetalol to be advantageous (El-Qarmalawi et al. Int J Gynecol Obstet 1995;49:125–30; Molvi et al. Arch Gynecol Obstet 2012;285:1553–62). Third, in women with CHTN, only 47% were enrolled before 21 weeks of gestation. Moreover, there was a lack of data regarding blood pressure values at first prenatal visit, when antihypertensive medications were started, when they escalated, and the doses used. Thus, the findings may not be fully generalisable to women with CHTN seen before 20 weeks of gestation. Fourth, the use of either labetalol or methyldopa was not randomized, and the number of subjects analysed was not adequate to answer the question of whether tight control of blood pressure in women with non-severe CHTN is associated with adverse outcomes such as SGA, abruption, or indicated preterm birth, which may be related to blood pressure level achieved during treatment or to the drug used. Consequently, the results from CHIPS and the present secondary analysis did not adequately answer the above questions. Practitioners may choose not to incorporate the findings into clinical practice. Additional well-powered studies are needed to address this issue in women with GHTN or with CHTN. A large multicentre study in 4500–5500 women with CHTN enrolled at before 18 weeks of gestation is underway in the USA (Clinicaltrials.gov NCT02299414). Full disclosure of interests available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Can gestational Hypertension Be modified By Treating nocturnal airflow Limitation?

Recent evidence suggests that women with gestational hypertension (GH) have a high rate of sleep disordered breathing (SDB), and treatment for even marginal SDB may improve blood pressure control in women with GH. We assessed whether the application SDB treatment could improve blood pressure in women with GH. This was a single-center randomized study. Subjects underwent an unattended home-based diagnostic sleep study. The study was then repeated with subjects wearing one of two randomly assigned treatments: auto-titrating continuous positive airway pressure (auto-CPAP) or mandibular advancement device (MAD) + nasal strip. First morning blood pressure and blood for standard GH measures plus inflammatory markers were taken after each study. Subjects completed a series of questionnaires addressing sleep quality and tolerance of assigned therapy. Twenty-four women completed the protocol-13 in the MAD group and 11 in auto-CPAP. The overall rate of SDB was 38%. Auto-CPAP was more effective at treating SDB than MAD + nasal strip, although the women randomized to MAD + nasal strip reported the greater comfort with therapy. First morning blood pressure was not consistently improved with either therapy. When subjects were stratified according to those whose blood pressure increased or decreased with therapy, an association was suggested between blood pressure improvement and reduced levels of tumour necrosis factor-α. We demonstrated that 38% of women with GH had concurrent SDB. We did not find an improvement in blood pressure or inflammatory markers with a single night of either the auto-CPAP or MAD + nasal strip interventions. However important lessons from this study may guide future investigations in this area.

Blood pressure and water regulation: understanding sex hormone effects within and between men and women

Cardiovascular disease remains the leading cause of death for both men and women. Hypertension is less prevalent in young women compared with young men, but menopausal women are at greater risk for hypertension compared with men of similar age. Despite these risks, women do not consistently receive first line treatment for the early stages of hypertension, and the greater morbidity in menopause reflects this neglect. This review focuses on ovarian hormone effects on the cardiovascular and water regulatory systems that are associated with blood pressure control in women. The study of ovarian hormones within young women is complex because these hormones fluctuate across the menstrual cycle, and these fluctuations can complicate conclusions regarding sex differences. To better isolate the effects of oestrogen and progesterone on the cardiovascular and water regulation systems, we developed a model to transiently suppress reproductive function followed by controlled hormone administration. Sex differences in autonomic regulation of blood pressure appear related to ovarian hormone exposure, and these hormonal differences contribute to sex differences in hypertension and orthostatic tolerance. Oestrogen and progesterone exposure are also associated with plasma volume expansion, and a leftward shift in the osmotic operating point for body fluid regulation. In young, healthy women, the shift in osmoregulation appears to have only a minor effect on overall body water balance. Our overarching conclusion is that ovarian hormone exposure is the important underlying factor contributing to differences in blood pressure and water regulation between women and men, and within women throughout the lifespan.

Blood Pressure Control in Hypertensive Women Aged 65 Years or Older in a Primary Care Setting. MERICAP Study

Introduction and objectives The available information regarding blood pressure control in women is scarce. This study was aimed at assessing blood pressure control and predictors of a lack of blood pressure control in the primary care setting in a large sample of hypertensive women. Methods Women aged 65 years or older with an established diagnosis of hypertension (≥6 months of evolution) were included in a cross-sectional, multicenter study. Blood pressure readings were taken following the current guidelines, and the value for each visit was the average of two separate measurements. Adequate blood pressure control was defined as <140/90 mmHg (<130/80 mmHg for diabetics). Results A total of 4274 hypertensive women (mean age: 73.6 years [6.1 years]) were included in the study; blood pressure was controlled in 29.8% (95% confidence interval: 28.4%-31.1%) of the study population. Combined therapy was administered in 67.6% of patients (46.3% with 2 drugs and 21.7% with 3 or more drugs). The most common organ damage was left ventricular hypertrophy (33.8%) and the most common associated condition was heart failure (19%). Poor blood pressure control was more frequent in patients with more cardiovascular risk factors, organ damage, and associated clinical conditions ( P<.01). A more recent hypertension diagnosis, LDL-cholesterol >115 mg/dl, monotherapy, obesity, and hemoglobin A 1c ≥7% were associated with a lack of blood pressure control ( P<.0001). Conclusions Only 3 in 10 hypertensive women aged ≥65 years monitored daily in the primary care setting achieved their blood pressure goals. A recent diagnosis of hypertension was the main predictor of poor blood pressure control.

Control de la presión arterial en las mujeres hipertensas de 65 o más años de edad asistidas en atención primaria. Estudio MERICAP

Introduction and objectives The available information regarding blood pressure control in women is scarce. This study was aimed at assessing blood pressure control and predictors of a lack of blood pressure control in the primary care setting in a large sample of hypertensive women. Methods Women aged 65 years or older with an established diagnosis of hypertension (≥6 months of evolution) were included in a cross-sectional, multicenter study. Blood pressure readings were taken following the current guidelines, and the value for each visit was the average of two separate measurements. Adequate blood pressure control was defined as <140/90 mmHg (<130/80 mmHg for diabetics). Results A total of 4274 hypertensive women (mean age: 73.6 years [6.1 years]) were included in the study; blood pressure was controlled in 29.8% (95% confidence interval: 28.4%-31.1%) of the study population. Combined therapy was administered in 67.6% of patients (46.3% with 2 drugs and 21.7% with 3 or more drugs). The most common organ damage was left ventricular hypertrophy (33.8%) and the most common associated condition was heart failure (19%). Poor blood pressure control was more frequent in patients with more cardiovascular risk factors, organ damage, and associated clinical conditions ( P<.01). A more recent hypertension diagnosis, LDL-cholesterol >115mg/dl, monotherapy, obesity, and hemoglobin A 1c ≥7% were associated with a lack of blood pressure control ( P<.0001). Conclusions Only 3 in 10 hypertensive women aged ≥65 years monitored daily in the primary care setting achieved their blood pressure goals. A recent diagnosis of hypertension was the main predictor of poor blood pressure control. Full English text available from: www.revespcardiol.org

Androgens and Hypertension

See related article, pp 788–794 It is now well accepted that blood pressure (BP) in normotensive men and prevalence of hypertension in men is greater than in women.1 After menopause, the prevalence of hypertension increases in women until it exceeds that in men.1 Because cardiovascular disease (CVD) is the leading cause of morbidity and mortality in both men and women, and hypertension is a leading risk factor for CVD, determining the mechanisms responsible for the sex differences in BP and prevalence of hypertension is important in protecting against CVD. Evidence suggests that androgens can contribute to BP control in women just as in men, because androgens are elevated in young women with conditions such as polycystic ovary syndrome,2 and there is evidence that androgens tend to increase in women after menopause.3 The mechanisms by which androgens control BP in both men and women remain to be elucidated. In the current issue of Hypertension , Wu et al4 extend their previous observations on the mechanisms responsible for androgen-mediated hypertension. They reported previously that treatment of male rats with 5α-dihydrotestosterone (DHT; 40 to 120 mg/kg body weight) caused an increase in BP and intrarenal expression of CYP4A and 20-hydroxy-5,8,11,14-eicosatetraenoic acid (20-HETE),5 that was prevented by CYP4A ω-hydroxylase inhibition (with HET-0016).6 In addition, DHT increased, and HET-0016 decreased, renal microvascular markers of oxidative stress. These data were the first to suggest that 20-HETE contributes to androgen-induced increases in oxidative stress. Subsequently, Ishizuka et al …

Gender and hypertension management: A sub-analysis of the I-inSYST survey

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in women. Aim. To evaluate blood pressure control, prevalence of concomitant cardiovascular risk factors, subclinical and clinical organ damage, and treatment according to gender. Methods. 11,562 patients (49% women) from the cross-sectional I-inSyst survey in primary care were included. Results. Blood pressure control in women (21.8%) and men (21.2%) was similar, despite a slightly older age (64.9 vs 63 years, p<0.0001). Women had less concomitant cardiovascular risk factors and organ damage, with the exception of diabetes, cerebrovascular and renal disease, than men. They received more antihypertensive drugs than men (1.7 ± 0.9 vs 1.5 ± 0.9, p<0.0001). Diuretics were more (45% vs 36.5%, p<0.0001), calcium-channel blockers (26% vs 29%, p<0.003) and angiotensin-converting enzyme inhibitors (20% vs 22%, p<0.02) were less commonly prescribed in women than in men. Different clinical factors (i.e. age, duration of hypertension, smoking) in women and men were associated with blood pressure control, but gender itself was not. Conclusions. In this group of treated hypertensive patients, blood pressure control in women and men was not different. Women had a lower prevalence of most cardiovascular risk factors, subclinical and clinical organ damage. Antihypertensive drug treatment varied according to gender.