Sex-specific cardiovascular morbidity and mortality in a cohort treated for hypertension

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Abstract
Incidence of cardiovascular disease (CVD) is higher in men than in women. The aim of this study was to investigate whether the gender differential can be modified by pharmacological intervention in a population-based setting. In a prospective population-based cohort – the Malmö Diet and Cancer study – a total of 3608 hypertensives (1559 men, 2049 women), 45–73 years old, with a mean of 10 years' treatment at baseline examination, participated in the study. Information on blood pressure-lowering medication was collected in a questionnaire. Incidences of first-ever cardiac event, stroke or CVD death were followed. The mean period of follow-up was 7.4 years. During follow-up, 341 first-ever CVD events and 128 CVD deaths occurred. The risk of CVD morbidity or mortality was significantly higher in hypertensive men than in hypertensive women: cardiac event [relative risk (RR) = 3.11; 95% confidence interval (CI): 2.13–4.54], stroke (RR = 1.50; 95% CI: 1.01–2.22) and CVD death (RR = 2.96; 95% CI: 1.86–4.20). However, the gender gap in CVD risks was reduced with advancing age. Two background factors – single household and concomitant diabetes – are apt to have an independent sex-specific impact on CVD risk. Gender remains a strong independent predictor for CVD morbidity and mortality, irrespective of antihypertensive intervention or other risk factors. Increased clinical attention should be given to hypertensive men living alone and hypertensive women with diabetes.