Sex Related Differences in Blood Pressure Variability in Hypertensive Patients: Cv-Prevital Study

Objective: Blood pressure (BP) regulation is influenced by biological effects of sex chromosomes, sex hormones and reproductive events. Gender-associated BP differences in humans are well known, with men having higher BP than age-matched pre-menopausal women, while after menopause higher prevalence of hypertension was observed in women. Less information is available on gender differences in BP variability (BPV), a BP-related feature known to independently predict cardiovascular outcomes. Aim of this study was to assess the differences in BPV between genders in participants of an ongoing prospective cardiovascular prevention trial (CV-PREVITAL). Design and method: The study included hypertensive patients without previous major cardiovascular events who responded to the advertisement campaign in outpatient facilities of Istituto Auxologico Italiano. In addition to clinical history, physical examination, standard routine blood tests, EKG and conventional office BP measurement, 24-hour ambulatory BP monitoring (validated oscillometric device TM2430, A&D, Japan) was performed at baseline. Short-term (24-hour) BPV was assessed as daytime and night-time standard deviation (SD) or average real variability (ARV). Results: The sample included 581 patients, with a mean age of 61.3±8.6 years and balanced gender distribution. Women had slightly lower BMI and 24-hour DBP and slightly higher 24-hour SBP then men. In most cases BPV estimates were higher in women. Principal BP and BPV variables in male and female participants are reported in Table 1. In multiple regression analysis gender remained independently associated with higher values of systolic (p<0.001 for day SD, p=0.022 for night SD and p=0.002 for ARV) and diastolic BPV (p<0.001 for day SD, p=0.004 for ARV 0.15, p<0.006) after adjusting for age, BMI, mean systolic and diastolic 24-hour BP and for 24-hour heart rate. We did not observe differences in BPV variables between pre- and postmenopausal women. Conclusions: In hypertensive patients female gender is independently associated with higher values of most short-term BPV estimates, regardless of menopausal status. Mechanistic and prognostic implications of this difference should be better understood.