A new analysis suggests, contrary to conventional thinking, that sex-specific changes in lifetime blood pressure trajectory may actually progress more rapidly and present differently in women compared to men.
The analysis, published in JAMA Cardiology, contrasted with the common belief that women lag behind men by one or two decades for the development of vascular disease. The authors said that this can create a scenario where women, whose blood pressure trajectories can differ relative to men, can present differently later on in life with cardiovascular disease.
“If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease,” the researchers wrote in their study. “Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases.”
The authors conducted a sex-specific analysis of blood pressure measures over a period of 43 years (1971 to 2014) in four community-based studies in the United States. Over 32,000 participants were included in the sample, 17,733 of whom were women (54%). The study outcomes of interest included changes in primary blood pressure [systolic, diastolic, mean arterial pressure (MAP) and pulse pressure (PP)] compared to baseline, as well as new-onset cardiovascular events.
Different Trajectories Between Sexes
According to the study results, women exhibited steeper increases in blood pressure in the third decade, which the authors reported continued through life (likelihood ratio test χ2=531 for systolic BP; χ2=123 for diastolic BP; χ2=325 for MAP; and χ2=572 for P; P<0.001 for all measures). These differences persisted between sexes even after adjusting for multiple cardiovascular disease (likelihood ratio test χ2=314 for systolic BP; χ2=31 for diastolic BP; χ2=129 for MAP; and χ2=485 for PP; P<0.001 for all measures).
“In contrast with the notion that important vascular disease processes in women lag behind men by 10 to 20 years, sex-specific analyses indicate that blood pressure measures actually progress more rapidly in women than in men, beginning early in life,” the authors said. “This early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men.”
Challenging cardiovascular dogma: for decades we were taught there's a 10-20 year vascular disease lag for women vs men. That appears to be wrong. https://t.co/17YgrR0kuC @JAMACardio @CedarsSinai Susan Cheng "Certain vascular changes .. earlier but also progress faster in women" pic.twitter.com/uXwRqjgIO7
— Eric Topol (@EricTopol) January 15, 2020
This new article debunks a prior belief: that women have Blood Pressure issues later in life compared to men. This study shows that women experience blood pressure issues earlier in life, and progresses more quickly than men.#KnowYourRisk #WomensHealthhttps://t.co/UdYJ6Qsy3R pic.twitter.com/878aBQU5cP
— Cleveland HeartLab (@CLEHeartLab) January 16, 2020
— Michelle Lin (@DrMichelleLin) January 15, 2020
Important study flagged by @EricTopol
"early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men."@CCriadoPerez https://t.co/WVLu2d5h9Z
— Jean Ledger (@LedgerJe) January 15, 2020