Hypertension in women: what is different?

Abstract

Hypertension is the number one killer for women, with a greater burden for women than men and it is an important risk factor for target organ damage. Women are less frequently affected by arterial hypertension than men during their reproductive life, but their risk catches up and exceeds men’s after menopause. There is a knowledge gap about the specificity of arterial hypertension in women due to an under inclusion of women in clinical trials. Hypertensive disorders during pregnancy are a recognised ulterior cardiovascular risk factor and obstetrical history must be part of the evaluation of hypertensive women. Furthermore, efficient cardiovascular prevention must be applied after pregnancies. Both endogenous and exogenous female sex hormones influence the blood pressure (BP) across life course, with specific characteristics relating to pregnancy, lactation, oral contraceptives, menopause, hormones substitution and elderly women. Altogether, effective treatment and control of hypertension ameliorates cardiovascular issues. Concerning medical treatment, due to the lack of data we propose to lower the doses of antihypertensive medications in women, due to increased efficiency and increased risk of secondary effects, most notably for thiazide diuretics and calcium channel blockers.