What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=663650). Intervention: Female sex vs. Male sex. Primary outcome: Uncontrolled hypertension (mean BP > 140/90 mmHg).

What does this research mean for the field?

More than half of patients with diagnosed hypertension in German routine care have uncontrolled blood pressure, with similar prevalence and lack of treatment intensification observed in both men and women. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to evaluate sex-specific differences in blood pressure control and antihypertensive therapy in Germany's routine care.

June 3, 2026

Sex Differences and Treatment Gaps in Uncontrolled Hypertension: Real-World Evidence From Germany

Key Result

Uncontrolled hypertension affected 55% of patients with documented blood pressure in German routine care, with similar prevalence and treatment patterns between women and men.

Key Points

The aim is to evaluate sex-specific differences in blood pressure control and antihypertensive therapy in Germany's routine care.
Secondary analysis of electronic medical records from outpatient practices in Germany.
Included adults (≥18 years) with hypertension, classifying them as controlled or uncontrolled.
Conducted sex-stratified analyses of blood pressure control and therapy patterns.
Among 663,650 patients diagnosed with hypertension, 55% had uncontrolled hypertension.
Antihypertensive therapy patterns were similar between men and women in both controlled and uncontrolled groups.
Common comorbidities included dyslipidemia (43% men, 40% women) and type 2 diabetes (31% men, 27% women).

Study Design

Type

Observational (n=663,650)

Multicenter

Yes

Structured PICO

Population

663,650 adults with a documented hypertension diagnosis in Germany, of whom 186,991 had documented blood pressure values, assessed for blood pressure control.

Outcome

Blood pressure control status (mean BP > 140/90 mmHg as threshold for uncontrolled)surrogate

Uncontrolled hypertension affects over half of German patients with a hypertension diagnosis, with similar prevalence and treatment patterns between men and women despite differing comorbidity profiles.

Main Result

Absolute Event Rate: 55% vs 55%

Abstract

Objective: Hypertension is a leading contributor to cardiovascular and renal disease. Despite effective therapies, blood pressure (BP) targets are often unmet in clinical practice. Real-world evidence on sex-specific aspects of BP control in Germany remains limited. The MapHTN project leverages electronic medical records (EMR) to assess BP control status and antihypertensive therapy in men and women with controlled and uncontrolled hypertension. Design and method: This secondary analysis used EMR data from outpatient general practice, cardiology, and internal medicine in Germany. Adults (>/= 18 years) with a documented hypertension diagnosis were included. Patients were classified as controlled or uncontrolled using mean BP above 140/90 mmHg as threshold. Diagnoses and comorbidities were identified via ICD-10-GM codes, medications via ATC codes. Sex-stratified analyses compared BP control, mean BP, ESH BP grades, antihypertensive therapy patterns, and comorbidity profiles. Results: In 2024, 663,650 patients had a hypertension diagnosis; 339,980 (51%) were female, 323,670 (49%) male. Documented BP values were available for 186,991 patients (28%); 51% female, 49% male. Among these, 55% had uncontrolled hypertension, 45% controlled. In the uncontrolled group, 51% were female and 49% male. Antihypertensive drug use was similar in controlled male vs. female patients (angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) 51% vs. 52%, beta-blockers 33% vs. 36%, calcium channel blockers 25% vs. 26%, diuretics 25% vs. 28%) and in uncontrolled patients (ACEi/ARB 53% vs. 54%, beta-blockers 25% vs. 31%, calcium channel blockers 28% vs. 27%, diuretics 21% vs. 24%). The most common comorbidities in male vs. female were dyslipidemia (43% vs. 40%), type 2 diabetes (31% vs. 27%), atherosclerotic disease (32% vs. 21%), coronary heart disease (27% vs. 15%), cardiorenal disease (21% vs. 20%), and obesity (18% vs. 18%). Conclusions: Uncontrolled hypertension affects more than half of patients with hypertension diagnosis in German routine care, with similar prevalence in women and men. Antihypertensive treatment patterns differ little between controlled and uncontrolled male and female patients, with limited evidence of treatment intensification despite substantial multimorbidity. These findings support systematic blood pressure monitoring and structured treatment escalation pathways to improve target attainment in women and men.

Bookmark