Higher burden of hypertension among men: prevalence, pharmacological treatment, and blood pressure control over up to 11 years of follow-up in the Brazilian Longitudinal Study of Adult Health

Background Hypertension is a major determinant of adverse cardiovascular outcomes, with a higher burden among men. One hypothesis concerns differences in prevalence, treatment, and control between genders. Purpose This study aims to describe sex-related differences in hypertension prevalence, pharmacological treatment, and blood pressure (BP) control rates over up to 11 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of civil servants living in six Brazilian cities. Methods Prospective longitudinal cohort study using data from the first (2008–2010), second (2012–2014), and third (2017–2019) visits of ELSA-Brasil. Hypertension was defined as BP ≥140/90 mmHg or use of antihypertensive medication. BP control was defined as BP <140/90 mmHg or <130/80 mmHg. At each visit, ratios of hypertension prevalence, pharmacological treatment, and BP control rates between sexes were analyzed using Poisson regression models with a log link function and robust variance estimator. Differences in trends across visits by sex were evaluated using generalized estimating equations, including interaction terms between visit and sex. Analyses were adjusted for age, race/skin color, and formal education level. Results A total of 15,088, 13,949, and 12,289 participants were included in visits 1, 2, and 3, respectively. Most participants were female (54%, 55%, and 56% at visits 1, 2, and 3, respectively). Men showed higher hypertension prevalence, lower pharmacological treatment rates, and lower BP control rates (<130/80 and <140/90 mmHg) compared with females, although with a progressive reduction in the difference between sexes (Table). Conclusions In an analysis spanning up to 11 years of ELSA-Brasil follow-up, despite a reduction in sex inequalities, men still have higher hypertension prevalence, lower pharmacological treatment proportion, and lower BP control rates than women.