Monday, February 11, 2008

Women less well managed than men with hypertension

Women less well managed than men with hypertension

By Caroline Price

11 February 2008

Hypertension 2008; Advance online publication

MedWire News: Two studies published in the journal Hypertension reveal gender disparities in the cardiovascular disease (CVD) management of patients with hypertension in the USA.

Indeed, one study found that women were significantly less likely than men to have their hypertension under control, as well as being less likely to receive CVD secondary prevention medications. In the second study, blood pressure (BP) control was not significantly inferior in women compared with men, but women had a higher prevalence of other concomitant CVD risk factors.

The studies are published in advance online to be included in a special edition of the journal highlighting women's unique risks for, and specific challenges in managing, hypertension.

Salomeh Keyhani (Mount Sinai School of Medicine, New York, USA) and colleagues examined data from the 2005 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which included a total of 12,064 patient visits with a primary care provider, 7786 for women and 4278 for men.

Among patients with hypertension, women were significantly less likely than men to meet BP goal levels, at 54.0% versus 58.7% (p<0.01). This relationship was also seen among older patients aged 65 to 80 years, at corresponding rates of 53.4% versus 63.2% (p<0.005). The lower rate of hypertension control among women compared with men in this age group persisted in multivariable models, at an odds ratio (OR) of 0.62.

Women were less likely to receive ACE inhibitors to treat their hypertension than men (20.9% vs 28.7%, p<0.001) and more likely to receive diuretics (20.9% vs 16.9%, p=0.05). However, no associations were found between gender and use of antihypertensive medication or the initiation of a new hypertensive-lowering medication in patients with uncontrolled hypertension.

Meanwhile, among patients with diabetes and hypertension, just 38.4% of women compared with 46.6% of men received an ACE inhibitor or angiotensin receptor blocker (OR=0.71). Women with ischemic heart disease and cerebrovascular disease were also less likely to receive aspirin (OR=0.43) and those with ischemic heart disease less likely to receive a beta blocker (OR=0.60) than men with these conditions.

The authors emphasize that the study "reveals suboptimal treatment for both men and women in a national sample," with less than 60% of all hypertensive patients having controlled BP and fewer than half receiving recommended therapies for chronic conditions. Nevertheless, they conclude that there is a "need for increased awareness of the persistent gender disparities in CVD management."

In the second study, Bernard Cheung (University of Birmingham, UK) and colleagues studied control of BP and the prevalence of five other CVD risk factors among 3475 adults with diagnosed hypertension in the National Health and Nutrition Examination Survey conducted between 1999 and 2004.

The researchers report that the age-adjusted prevalence of uncontrolled BP was not significantly different between men and women, at 50.8% and 55.9%, respectively, and did not change significantly over the study period.

However, central obesity, elevated total cholesterol levels, and low high-density lipoprotein cholesterol levels were all significantly more common among men than women (all p<0.05).

Cheung et al conclude: "Although there is still room for improvement in BP control, our study has highlighted the importance of addressing other concomitant cardiovascular risk factors in women."


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