Cardiovascular disease in women: Gender-specific aspects of hypertension and the consequences of treatment

The epidemiology, clinical course, response to treatment, and ultimate outcome of essential hypertension vary as a function of gender. Three early trials on hypertension reported an increase in all-cause mortality in treated white women compared with black women or with men of both races. Later studies, however, suggest that drug therapy has similar and beneficial effects in hypertensive men and women. Women may tolerate hypertension better than do men. Diastolic hypertension correlates with higher mortality from coronary artery disease in men than in women. Special considerations apply to treating the hypertensive woman. Use of oral contraceptives may precipitate or accentuate the problem. In contrast, in the postmenopausal female, estrogen replacement may actually improve hypertension, via several mechanisms. These include the impact of the hormone on vasomotricity, its enhancement of baroreceptor sensitivity, and its impact on the hyperinsulinemia characteristic of menopause. Treatment of hypertension must be individualized with respect to gender. More data on the consequences of treatment of women with hypertension are needed, particularly longterm studies to assess the impact of treatment on mortality.