High blood pressure in younger people can be especially dangerous for women, suggests a new study. The study found that women – but not men – with slightly elevated blood pressure in their early 40s may have a significantly increased risk of later coronary disease and death.
In 1992 Norwegian researchers began studying 12,329 men and women with a mean age of 41 years. They tracked their blood pressure and cardiovascular health for an average of 16 years.
At the beginning, high blood pressure was significantly less common in women than in men: 25 percent of women and 35 percent of men had stage 1 hypertension, which the American Heart Association defines as a reading of 130/80 to 139/89. (A value below 120/80 is considered normal.) 14 percent of women and 31 percent of men had stage 2 hypertension, defined as 140/90 or higher. The women also had fewer risk factors for heart disease: they tended to have lower BMIs and lower cholesterol levels, and fewer of them were smokers.
During the follow-up period, 1.4 percent of women and 5.7 percent of men with cardiovascular disease were hospitalized or died from it.
Compared to women who had normal blood pressure at the start of the study, those with stage 1 high blood pressure were more than twice as likely to develop heart disease. This relationship was not statistically significant in men. The study, in the European Journal of Preventive Cardiology, controlled diabetes, BMI, cholesterol, smoking, and physical activity.
The authors acknowledge that the study had limitations. It was conducted in a small geographic area in Norway and the subjects were mainly Caucasian. In addition, the researchers did not have any information about treating high blood pressure or using cholesterol-lowering drugs during the follow-up period.
Still, "the emerging evidence is that high blood pressure is worse for female hearts than for males," said lead author, Dr. Ester Kringeland, a specialist in internal medicine at the University of Bergen in Norway, "and the risk starts with lower" blood pressure values in women. "
Dr. Not involved in the work, Joyce M. Oen-Hsiao, assistant professor of medicine at Yale, said, “It's a well-designed study. Most of us just look at risk factors, and we never really break them down by gender. That is the novelty of this paper – that there is a statistical difference between men and women. And if we can transfer this result to our more diverse populations, it will transform primary prevention. "
Current guidelines from the American Heart Association state that in otherwise healthy people, high blood pressure up to 130/80 can usually be treated with lifestyle changes. For values from 130/80 to 139/89, the group recommends antihypertensive drugs, but only for people with other risk factors for cardiovascular diseases. From 140/90 onwards, medication is indicated in almost all cases. But the guidelines make no distinction between men and women.
Dr. Kringeland said taking a reading or taking a home blood pressure monitor is not enough to make a diagnosis. “A doctor has to take three measurements, then the average of the last two. And to diagnose high blood pressure, you need at least two visits to the doctor. "
The question of whether a healthy woman in her 40s with a score of 130/80 should be treated with antihypertensive drugs has not yet been clarified.
"In some women – for example diabetics – treatment at this level is indicated," said Dr. Kringeland. “But with women who are otherwise healthy? We don't have an answer yet. Blood pressure medication has side effects and you need to consider the benefit-risk balance. We need more research on heart disease in women. "