Sex differences in hypertension incidence and risk factors: a population-based cohort study in Southern Iran

BACKGROUND: Hypertension (HTN) is a major global public health concern. This study aims to identify gender differences to inform more effective prevention strategies and targeted management approaches. METHODS: This prospective cohort study included 7,710 participants aged 40 to 70 years, with a mean follow-up duration of 5.2 years. HTN was defined using European hypertension management guidelines. A Cox regression model was employed to determine factors associated with HTN, adjusting for confounding variables effects. RESULTS: During the mean follow-up period of 5.2 years, the incidence rate of hypertension was 21.54 per 1,000 person-years, with females exhibiting a higher incidence than males. Several significant predictors of HTN were identified. In men, key risk factors included age (60-70 years, 2.83-fold increase, 95% CI 2.05-3.92), high waist-to-height ratio (5.63-fold increase, 95% CI 2.42-13.07), smoking (2.68-fold increase, 95% CI 1.04-6.91), and opium use (1.93-fold increase, 95% CI 1.06-3.49). In women, significant predictors included age (60-70 years, 3.65-fold increase, 95% CI 2.59-5.15), contraceptive drug use (1.24-fold increase, 95% CI 1.01-1.52), high waist-to-height ratio (1.87-fold increase, 95% CI 1.19-2.92), pre-HTN (3.64-fold increase, 95% CI 3.01-4.40), and kidney stones (1.32-fold increase, 95% CI 1.06-1.65). CONCLUSION: This study identified key predictors of hypertension (HTN) with notable gender differences. For men, significant risk factors included age, high waist-to-height ratio, smoking, and opium use; for women, the prominent predictors were age, contraceptive use, pre-HTN, and kidney stones. These findings highlight the need for gender-specific strategies in HTN prevention and management, focusing on modifiable risk factors by gender.