Uncontrolled Hypertension More Likely in Younger Men, Older Women, Study Finds

More than one-third of US adults taking antihypertensive medication continue to have uncontrolled hypertension, and younger men and older women are at the greatest risk, according to research presented at the American Heart Association’s Hypertension Scientific Sessions 2021, held virtually Sept. 27-29, 2021.

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Investigators found that men aged 20 to 49 years were up to 70% more likely to have uncontrolled hypertension than women of the same age. The likelihood of persistent uncontrolled hypertension while on medication shifted to women at approximately age 70 years at which time their risk for having elevated blood pressure (BP) was 29% to 63% higher than for men of that age.

Study authors say their results suggest that women aged ≥70 years and men younger than age 50 require closer monitoring for uncontrolled hypertension, even if they are being treated.

“Blood pressure control remains a major public health challenge that impacts even those being treated for the disease,” said lead author Aayush Visaria, MD, MPH, a postdoctoral research fellow at Rutgers Institute for Health, Health Care Policy and Aging Research at Rutgers University in New Brunswick, NJ, in an AHA press statement.

“Although we know that women tend to have an accelerated increase in blood pressure and cardiovascular disease risk after menopause, we have little information on whether blood pressure control is different by gender and whether it changes with age,” added Visaria in the statement.

“Although we know that women tend to have an accelerated increase in blood pressure and cardiovascular disease risk after menopause, we have little information on whether blood pressure control is different by gender and whether it changes with age.”

To look more closely at the potential correlations, Visaria and colleagues examined data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). The study included 13 253 adults, aged ≥20 years who were taking prescribed medications to treat hypertension. The average age was 57 years; 52% were women; and 71% were non-Hispanic white.

Researchers evaluated rates of hypertension control using the definition of hypertension from the 2014 Joint National Commission, >140/90 mm Hg, and the definition advanced by the 2017 AHA.ACC guideline, >130/80 mm Hg

They compared rates of uncontrolled hypertension among men vs women across 10-year age-groups and found:

• Differences in odds of uncontrolled hypertension were similar regardless of the guideline criteria for high blood pressure.
• Overall, 34% of those in the study had uncontrolled hypertension.
• From ages 20 to 29, the odds of having uncontrolled hypertension were 59% higher for men compared to women, based on the AHA/ACC guideline definition of high blood pressure.
• Among all participants aged 30-39, men were 70% more likely to have uncontrolled disease vs same-aged women, and for all those aged 40-49 men were 47% more likely to have uncontrolled hypertension.
• From ages 50 to 69, women and men had similar odds of uncontrolled hypertension.
• When the AHA/ACC guideline definition was used to assess hypertension (>130/80 mm Hg) among all participants aged ≥70 years, women had 29% (aged 70-79) to 63% (aged 80+) higher odds of uncontrolled hypertension vs men.

“In general, there is a need to increase awareness about uncontrolled hypertension among older women and younger men, and further studies need to be done to understand the reasons behind this phenomenon,” advised Visaria in the statement.

The cross-sectional nature of the study was cited as a limitation to which Visiaria added: “In order to really determine whether uncontrolled hypertension rates are changing in women versus men across age, a prospective study where blood pressure measurements are tracked over time in women and men with hypertension is ideal,” Visaria said.

Source: Visaira A, Hameed F, Raval B, Islam S. Gender differences in blood pressure control is mediated by age in United States adults. Hypertension. 2021;78:A54. Originally published online Aug 27, 2021 https://doi.org/10.1161/hyp.78.suppl_1.54