Sex differences in blood pressure variability in office, home and ambulatory measurements

BACKGROUND: Hypertension is widely recognized as a significant risk factor for cardiovascular diseases. Beyond merely focusing on blood pressure levels, there is growing recognition of the importance of considering blood pressure variability (BPV). AIMS: The aim of this study was to compare factors influencing BPV in men and women in office and out-of-office measurements. METHODS: The study enrolled 120 women and 99 men recruited from an outpatient clinic between 2021 and 2022. All participants underwent a medical interview. Subsequently, office blood pressure measurements were conducted using two methods - unattended and attended measurements Following this, 24-hour ambulatory blood pressure monitoring was performed, and participants were instructed to conduct home blood pressure measurements for 7 days. Laboratory tests, echocardiography and carotid artery ultrasound were performed thereafter. RESULTS: BPV was higher in women, in older patients, those with diabetes and smokers. Female sex remained significant determinant of higher BPV in multiple regression analysis (b = -0.299; P = 0.002) after adjustment for age (b = 0.247; P = 0.01), body mass index (b = 0.012; P = 0.89), diabetes (b = -0.155; P = 0.08), smoking (b = 0.063; P = 0.48) and blood pressure values (b = 0.478; P <0.001). BPV is associated with parameters of subclinical organ-damage and this relationship is stronger for women than men. CONCLUSIONS: Women exhibit higher BPV despite having lower blood pressure. Reducing the BPV, a multifaceted phenomenon related to organ damage, necessitates integrated intervention focused on optimizing blood pressure values on one hand, and managing metabolic risk factors and lifestyle modifications, notably including tobacco cessation, on the other.