Key result
Optimal CVD risk corresponds to ~10 mmHg lower systolic blood pressure in women than men.
Why the study?
Recent studies suggest CVD risk increases from a lower SBP nadir and at a greater rate in women than men, leading to proposals for sex-based SBP thresholds.
Do sex differences exist in the association between blood pressure levels and incident cardiovascular disease in adults without prior cardiovascular disease?
Cohort (n=420,649)
Yes
Do sex differences exist in the association between blood pressure levels and incident cardiovascular disease in adults without prior cardiovascular disease?
Despite relative cardiovascular risk increasing at lower blood pressure levels in women compared to men, women's absolute cardiovascular risk remains lower than men's across all blood pressure strata, supporting the use of uniform, non-sex-specific diagnostic thresholds for hypertension.
Absolute CVD risks remain higher in men across all SBP levels despite lower nadir in women; leaves open whether sex-specific hypertension thresholds warrant prospective trials.
Background Recent studies show that cardiovascular disease (CVD) risk increases from a lower nadir of systolic blood pressure (SBP) in women than men, and increases thereafter at a greater rate. This has led to a suggestion that sex-based SBP thresholds are required. We investigated sex differences in the associations of SBP and incident atherosclerotic CVD. Methods This prospective study included 420,649 UK Biobank participants with no prior history of CVD. Age-adjusted sex-specific risks, relative risks (RRs), and risk differences (RDs) relating SBP to CVD were estimated using Poisson and Cox regression. Results Over 13.6 years of follow-up, there were 28,628 CVD events. CVD risks across BP levels showed a “J-shape,” and were higher in men than women at all BP levels. The lowest risks were at SBP 100-<105 mmHg (events per 10,000 person-years [95% CI]: 15.6 [11.8-19.4]) and 110-<115 (47.2 [41.4-53.0]) among women and men, respectively. Compared with SBP 100-<110, sex-specific RRs at above 120 were higher in women than men, but RDs were higher in men than women at all levels of SBP. Compared to men at 110-<115 (ie, the men with least risk), risks in women were lower at all levels of SBP below 170. Conclusions CVD risk is lowest for women at a slightly lower SBP than men and RRs for CVD increase with SBP at a slightly steeper rate in women. However, both risks and RDs in women are never greater than in men. This evidence does not support lower thresholds for diagnosis of hypertension in women.
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Kelly et al. (2025) conducted a cohort in Incident atherosclerotic cardiovascular disease (n=420,649). Blood pressure levels vs. Lowest risk blood pressure reference groups was evaluated on Incident atherosclerotic cardiovascular disease (fatal or non-fatal coronary heart disease or stroke). CVD risk was lowest at a slightly lower systolic blood pressure in women (100-104 mmHg) than men (110-114 mmHg), but absolute CVD risk was higher in men than women at all blood pressure levels.
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