Sex Differences in Hypertension Prevalence, Treatment and Control in Older People in Germany: Results of the Natinal Examination Survey Gesundheit 65+

Objective: As hypertension is closely linked to cardiovascular events, blood pressure (BP) levels and management in populations are a vital public health concern. A gender gap with higher awareness, treatment and control of hypertension in women, especially in younger women, has been repeatedly reported. We analyze recent national BP data of the Gesundheit 65+ study in older and very old men and women in Germany 2022-2023. Design and method: Nationally representative examination survey of the population aged 65 years and older residing in Germany. We analysed self-reported hypertension diagnoses, the mean of the second and third standardized oscillometric BP measurements (Mobil-O-Graph) with one of five cuffs according to upper arm circumference and Anatomical Therapeutic Chemical- (ATC) coded medication in the past 7 days. Hypertension was defined as mean systolic BP (SBP) at or above 140 mm Hg, or mean diastolic BP (DBP) at or above 90 mm Hg, or use of antihypertensives (ATC-codes C02 antihypertensives, C03 diuretics, C07 beta-blockers, C08 calcium-channel blockers or C09 ACEI and ARB) in participants with self-reported hypertension diagnosis. Awareness was defined as self-reported BP diagnosis in those with hypertension according to study definition. Provisional population weights were used. Results: BP was measured and hypertension status defined in 743 men and 686 women aged 65 to 100 years. The prevalence of hypertension according to our study definition was 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. There were no sex differences in awareness among hypertensives (men 81.7%, women 81.2%), nor in treatment among aware hypertensives (97.5% in men and women). However, control among treated hypertensives differed considerably: while 75.7% [69.2; -81.2] of men with treated hypertension had BP at or below 140/90, control among treated in women was only at 61.4% [54.2-; 68.1]. Conclusions: Our 2022-2023 national blood pressure data of people aged 65 years and older in Germany suggest a new gender gap with less hypertension control in older women compared to older men which was not yet apparent a decade ago and stands in contrast to findings in younger adults across many studies.