Sex differences in the efficacy of diuretics in the treatment of hypertension; a systematic review and meta-analysis

Background: Pharmacological treatment of high blood pressure is considered essential in the prevention of cardiovascular morbidity and mortality, but sex differences may disturb effectiveness. The aim of this systematic review and meta-analysis was to evaluate possible differences in effects for diuretics on blood pressure, heart rate and cardiac function in female compared to male hypertensive individuals. Methods: We performed a systematic review and meta-analysis on studies on diuretics from 1945 to May 2020. Studies had to present both baseline and follow-up measurements of the interested outcome variables and present data sex-stratified. Mean differences were calculated using a random-effects model. Results: Eighteen studies investigating on diuretics were used in this review. The effect of diuretics on blood pressure was clinically significant in both females and males and more profound in chronic treatment. Heart rate and left ventricular ejection fraction did not change significantly throughout treatment in both sexes, but cardiac output decreased significantly in females. Changes in left ventricular mass were only significant in males. Conclusion: Diuretics decreased blood pressure in both sexes, especially when used chronically. Nonetheless, sex depending differences on blood pressure, cardiac output and left ventricular mass may suggest diversity in response to diuretics, implying the importance of considering sex-specific treatment strategies.