Key result
Compared to blood pressure <120/80 mm Hg, levels ≥140/90 mm Hg significantly increased the risk of major adverse cardiac and cerebral events (HR 1.819), with risk increasing at lower thresholds in women than men.
Why the study?
Despite clinical differences in hypertension between men and women, optimal blood pressure targets remain debated.
Do different blood pressure levels increase the risk of MACCEs differently in men versus women among antihypertensive-treated patients?
Cohort (n=98,267)
Do different blood pressure levels increase the risk of MACCEs differently in men versus women among antihypertensive-treated patients?
In antihypertensive-treated patients, the blood pressure threshold associated with an increased risk of MACCEs is lower in women (≥130/80 mm Hg) than in men (≥140/90 mm Hg).
Hypertension is a leading risk factor for cardiovascular events and death. Despite differences in clinical implications of hypertension between men and women, guidelines establishing optimal blood pressure (BP) targets are still debated. The aim of this study was to investigate sex differences in the BP level associated with increased risks of major adverse cardiac and cerebral events (MACCEs) among antihypertensive-treated patients. Using data from the Korean National Health Insurance Service-National Sample Cohort, we enrolled antihypertensive-treated patients and divided them into four categories: Group 1: SBP < 120 and DBP < 80 mm Hg; Group 2: 120 ≤ SBP < 130 and DBP < 80 mm Hg; Group 3: 130 ≤ SBP < 140 or 80 ≤ DBP < 90 mm Hg; and Group 4: SBP ≥ 140 or DBP ≥ 90 mm Hg. We performed time-dependent cox regression analysis to investigate sex differences in the BP levels that increased the risk of MACCEs. Most of the 98 267 patients fell into Group 3 (53.2% men and 52.8% women) and Group 4 (30.5% men and 28.1% women). During 8.34 ± 2.07 years, there were 8,813 MACCEs and 791 deaths. The incidences of MACCEs and death tended to increase as the BP increased in both sexes. Compared to Group 1, the risk of MACCEs significantly increased only in Group 4 for men, while it significantly increased in Groups 3 and 4 for women. This study shows that there are sex differences in the BP level at which the risk of MACCEs increases. Our finding suggests that sex should be significantly considered when determining the optimal BP target in patients undergoing hypertension treatment.
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Kee et al. (2020) conducted a cohort in Hypertension (n=98,267). Blood pressure ≥140/90 mm Hg vs. Blood pressure <120/80 mm Hg was evaluated on First occurrence of a major adverse cardiac and cerebral event (MACCE) (HR 1.819, 95% CI 1.181-2.802, p=0.007). Compared to blood pressure <120/80 mm Hg, levels ≥140/90 mm Hg significantly increased the risk of major adverse cardiac and cerebral events (HR 1.819), with risk increasing at lower thresholds in women than men.
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