The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011

Abstract

Hypertension is a major risk factor for cardiovascular morbidity; therefore, its control is very important. International Guidelines recommend the same hypertension management in men and women; however, studies suggest that management of hypertension differs. This study explores gender-age disparities in the management and control of hypertension in Germany in 1998 and 2008-2011. Data from the German Health Examination Surveys (GNHIES98 1998, n=7124 and DEGS1 2008-2011, n=7988, age 18-79 years), including standardized blood pressure measurements and Anatomical Therapeutic Chemical medication codes, were analyzed by gender and two age groups. For 1998 and 2008-2011 in Germany, the gender gap in hypertension management persisted without significant changes. Hypertensive men in 2008-2011 had lower awareness of their condition (78.3 vs. 86.8%), less treatment for hypertension (65.3 vs. 79.2%), less control of hypertension (45.4 vs. 57.5%) and less treatment among those aware of their condition (83.9 vs. 91.5%) than did women. These gender differences were greater in younger compared with older adults (18-54 years vs. 55-79 years). No gender differences were observed in control of hypertension among those treated in 1998; however, subsequent improvement was less in younger men compared with the other age-gender groups, leading to a new gender gap in 18-54-year olds (women 84.8%, men 63.9%). Younger women used more β-blockers and less angiotensin-converting enzyme inhibitors (ACEI) than younger men. Factors positively associated with control among those treated for hypertension in the younger group were being a woman, using β-blockers or using ACEI, or angiotensin-receptor blockers. In the older group, diabetes was negatively associated with control of hypertension, whereas having cardiovascular comorbidities was positively associated. Gender disparities in hypertension management and control still exist in Germany but may be masked because they are age-dependent.