Sex differences in the pharmacological treatment of hypertension

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Abstract
To summarize all available literature on sex differences in the pharmacological treatment of hypertension with respect to the percentage of hypertensive patients treated pharmacologically and the selection of antihypertensive drugs. The influences of the calendar period, age, definition of hypertension, prevalence of hypertension and country on these sex differences were examined. A secondary analysis of data from 46 population-based studies in 22 countries on the prevalence of pharmacologically treated hypertension was conducted to estimate sex ratios for the prevalence of drug treatment for hypertension. Overall, women with hypertension were 1.33-fold [95% confidence interval (CI) 1.32–1.34] more likely to be treated pharmacologically for hypertension than were hypertensive men. With increasing age, the female : male ratio for pharmacological treatment of hypertension decreased from 2.26 (95% CI 1.56–3.27) at ages 20–29 years to 1.22 (95% CI 1.11–1.34) at ages 60–69 years. In all countries more women than men were treated for hypertension, with the biggest difference observed in the USSR (1983–1986), where about twice as many women as men were treated for hypertension. Women more frequently used diuretics, whereas men more often used β-blockers, angiotensin converting enzyme inhibitors and calcium antagonists. Hypertensive women are more often treated for hypertension than hypertensive men and their pattern of use of antihypertensive drugs differs from that of men. Further research is required in order to explain sex differences in the treatment of hypertension with respect to the prevalence of pharmacological treatment of hypertension and choice of antihypertensive drugs, and to investigate the consequences of this difference for long-term outcomes.