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

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.