High Blood Pressure in Women

ABSTRACT The aim of this study was mainly to determine the prevalences of primary and secondary arterial hypertension in middle‐aged women and of symptoms, signs and metabolic effects of increased blood pressure per se or antihypertensive treatment, and to study the prognosis for women with hypertension. The study was part of a comprehensive longitudinal population study of middle‐aged women which started as a cross‐sectional study in 1968–69 (1462 participants, participation rate 90.1%). The same sample was re‐studied in 1974–75 (1302 participants, participation rate 89.1%) and in 1980–81 (1154 participants, participation rate 78.9% of those studied in 1968–69). Arterial hypertension was defined as systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure > 95 mm Hg (phase 5) or both. Women on anti‐hypertensive treatment were also considered hypertensive irrespective of the blood‐pressure levels. Altogether 192 women (13.1%) were considered to be untreated hypertensives and 68 women (4.7%) were on antihypertensive treatment at the time of the initial study. Secondary hypertension was found to account for 4.6% and surgically curable hypertension less than 1% of all causes of hypertension. Headache and dizziness were more often reported by those women who were on antihypertensive drugs, but when studied longitudinally only dizziness appeared as a new symptom more often in those who started antihypertensive treatment compared to the non‐hypertensive women (p < 0.05). It was especially common in those who started to take diuretics. Thirtyfour previously untreated women started taking diuretics and 52 β‐blockers as the sole antihypertensive drug after the initial study and were still on these drugs in 1974–75. An increase in serum triglyceride concentration was found in women started on β‐blcckers and a slight increase in serum uric acid in those started on diuretics. Serum cholesterol and blood glucose were unimpaired. There was an overrepresentation of diabetes nellitus in women starting antihypertensive treatment during the 12‐year follow‐up period (p < 0.001, relative risk 6.0). The increased incidence of diabetes mellitus could not be related to any particular antihypertensive drug. A 12‐year follow‐up of the population sample with respect to morbidity from cerebrovascular and cardiovascular diseases and total mortality is presented. Neoplasms were the most common cause of death. The morbidity from myocardial infarction and stroke and the total mortality were higher than expected in the group of women who were already on antihypertensive treatment at the time of the initial study, but no higher than expected in women whose hypertension was discovered in 1968–69 and who were offered continuous medical care throughout the period (expected figures calculated from age‐specific incidence rates in the total population sample). The preventive implications seem obvious. Early detection of arterial hypertension and continuous medical care, including antihypertensive treatment when needed, seem to lengthen the life of women without diminishing their quality of life.