Older Women, Younger Men Most Apt to Struggle With BP Control

Megan Brooks

October 04, 2021

Women 70 years and older and men aged 20 to 49 years with hypertension are more likely to have uncontrolled blood pressure (BP) despite taking BP-lowering medications, according to a new study.

"All of the participants are taking prescription antihypertensive medications and all have diagnosed hypertension so there's no reason for them to have uncontrolled hypertension," said study author Aayush Visaria, MD, MPH, with Rutgers Institute for Health, Health Care Policy and Aging Research in New Brunswick, New Jersey.

The findings suggest that women aged 70 and older and men younger than age 50 should be more closely monitored for uncontrolled hypertension even if they are being treated, Visaria said.

He presented the study September 29 at the American Heart Association (AHA) Hypertension Scientific Sessions 2021. 

Major Public Health Challenge

BP control remains a "major public health challenge" for even those being treated for the disease, Visaria noted in his presentation. Yet, little is known about the gender differences in BP control across the age spectrum.

To investigate, the research team analyzed data from National Health and Nutrition Examination Surveys (from 1999-2018) for 13,253 adults diagnosed with hypertension and taking antihypertensive medication. The average age in the cohort was 57 years, 52% were women, and 71% were White.

The researchers assessed rates of hypertension control, defined as BP 140/90 mm Hg or higher, as defined in the 2014 Joint National Commission guidelines, or BP 130/80 mm Hg or higher, as defined by the 2017 AHA/American College of Cardiology (ACC) guidelines.

Overall, 34% of the cohort had uncontrolled hypertension. Differences in the odds of uncontrolled hypertension were similar regardless of the definition used.

Key findings based on the AHA/ACC definition include:

  • Among adults aged 20 to 29 years, the likelihood of uncontrolled hypertension was 59% higher in men than women (adjusted odds ratio [aOR], 0.41; 95% CI, 0.19 - 0.87).

  • Among those in the 30 to 39 age bracket, men were 70% more likely than women to have uncontrolled hypertension (aOR, 0.30; 95% CI, 0.21 - 0.43).

  • Among adults aged 40 to 49 years, men were 47% more apt to have uncontrolled BP (aOR, 0.53; 95% CI, 0.39 - 0.73). 

  • From age 50 to 69 years, women and men had similar odds of uncontrolled hypertension. However, for the 70+ age bracket, compared with men, women had 29% higher odds of uncontrolled hypertension at age 70-79 (aOR, 1.29; 95% CI, 1.04 - 1.59) and 63% higher odds at age 80+ (aOR, 1.63; 95% CI, 1.23 - 1.49).

"This is in line with literature demonstrating accelerated increase in blood pressure postmenopause and it really suggests that there is a need to improve blood pressure control in older women and there might be possible mortality benefits as well," Visaria said.

"A Call to Action"

Weighing in on the study, Maryann McLaughlin, MD, cardiologist at Mount Sinai Hospital, New York City, said this study "brings to light that younger men ages 20 to 49 are more likely to have uncontrolled hypertension."

"It's really a call to action to discuss with men in that age group the importance of adhering to medications that they're prescribed, but also to address lifestyle changes such as low sodium diet, adequate exercise, and monitoring of their blood pressures at home," McLaughlin told theheart.org | Medscape Cardiology.

"I think what we're moving toward is that all patients with a diagnosis of hypertension should have a home blood pressure monitor and should be required to periodically do logs of their blood pressure at home and send them to their physician so that the physician will know whether they're really controlled or not," McLaughlin said.

"In my opinion, proper cardiac care is to provide or encourage patients to have a home blood pressure monitor, and be part of their treatment plan," she said.

As for the finding in older women, McLaughlin said, "we know that women usually have lower blood pressure than men at the younger ages, but after menopause, and especially 10 years after menopause, that's when the blood pressures seem to accelerate in women. The fact that it's less well controlled than men in that age group is surprising."

The study had no funding. Visaria and McLaughlin have disclosed no relevant financial relationships.

American Heart Association Hypertension Scientific Sessions 2021. Presentation 54. Presented September 29, 2021.

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