Key result
Midlife stage 1 hypertension linked to ~2-fold higher LVH risk in women, but not men.
Why the study?
Women with hypertension have a higher prevalence of LVH than men, and it was unknown whether midlife BP carries a different risk of LVH later in life for women and men.
Does midlife stage 1 or stage 2 hypertension increase the risk of developing left ventricular hypertrophy 26 years later in women and men compared to normotension?
Cohort (n=2,126)
Does midlife stage 1 or stage 2 hypertension increase the risk of developing left ventricular hypertrophy 26 years later in women and men compared to normotension?
Stage 1 hypertension in the early 40s is an independent risk factor for developing left ventricular hypertrophy 26 years later in women, but not in men, highlighting sex-specific vulnerability to mildly elevated midlife blood pressure.
May inform sex-specific LVH risk assessment in women; extends observational data but leaves causal effects and practice change open.
Background Women with hypertension have higher prevalence of left ventricular hypertrophy (LVH) than men. It is not known whether blood pressure (BP) in midlife carries a different risk of LVH later in life for women and men. Purpose Our aim was to assess sex specific associations between BP categories in midlife and LVH later in life Methods We tested associations between BP at age 42 (baseline) with LVH 26 years later (follow-up) among 1,170 women and 956 men participating in the population-based Hordaland Health study. Participants were grouped by baseline BP category: Normotension (BP < 130/80 mmHg), stage 1 (BP 130-139/80-89 mmHg) and stage 2 hypertension (BP ≥140/90 mmHg). LVH was identified by echocardiography as left ventricular mass/height2,7 exceeding sex-specific thresholds. Associations between BP category and LVH were assessed in sex-specific logistic regression analyses, with normotension as the reference category. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). Results At baseline, a lower proportion of women than men had stage 1 and 2 hypertension, respectively, (24 vs. 35% and 10 vs. 27%, P < 0.001). At follow-up, 8% of women and 11% of men had LVH (P =0.04). In unadjusted analysis, both stage 1 and stage 2 hypertension were associated with LVH in women, OR 2.40 (95% CI 1.53-3.77) and OR 2.00 (1.04-3.82) but not in men OR 1.00 (95% CI 0.62-1.62) and OR 1.21 (95% CI 0.74-2.00). After adjustment for baseline diabetes, smoking, serum-total-cholesterol, and body mass index, stage 1 hypertension remained associated with LVH in women (OR 2.00 [95% CI 1.26-3.18]) while the association between stage 2 hypertension and LVH was attenuated (OR 1.38 (0.68-2.78]), reflecting the importance of concomitant overweight. In men the associations between baseline BP and LVH remained non-significant also in multivariable analyses (both p>0.05). A significant interaction between BP categories and sex confirmed that these associations differed between women and men. Conclusion Among individuals in their early 40s, stage 1 hypertension was a strong risk factor for LVH later in life in women, but not in men. These results add to the increasing body of evidence documenting that even mildly elevated BP in midlife promotes organ damage in women.
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Kringeland et al. (2026) conducted a cohort in Hypertension and Left Ventricular Hypertrophy (n=2,126). Stage 1 and Stage 2 hypertension in midlife vs. Normotension (BP < 130/80 mmHg) was evaluated on Left ventricular hypertrophy (LVH) identified by echocardiography as left ventricular mass/height^2.7 exceeding sex-specific thresholds (OR 2.00, 95% CI 1.26-3.18). Midlife stage 1 hypertension independently increased the risk of left ventricular hypertrophy 26 years later in women (adjusted OR 2.00; 95% CI 1.26-3.18), but not in men (p>0.05).
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