Systolic blood pressure associated with the lowest cardiovascular risk is lower in women (100-<105 mmHg) than men (110-<115 mmHg), but absolute risks in women never exceed those in men.
Cohort (n=420,649)
Are there sex differences in the association between systolic blood pressure and incident atherosclerotic cardiovascular disease?
This study demonstrates that while relative risks for CVD increase at a slightly steeper rate with SBP in women, absolute risks and risk differences are never greater than in men, challenging recent suggestions for lower hypertension diagnostic thresholds in women.
Abstract Background Recent studies show that cardiovascular disease (CVD) risk increases from a lower nadir of systolic blood pressure (SBP) in women than men, and increases thereafter at a greater rate. This has led to a suggestion that sex-based SBP thresholds are required. We investigated sex differences in the associations of SBP and incident atherosclerotic CVD. Methods This prospective study included 420,649 UK Biobank participants with no prior history of CVD. Age-adjusted sex-specific risks, relative risks (RRs), and risk differences (RDs) relating SBP to CVD were estimated using Poisson and Cox regression. Results Over 13.6 years of follow-up, there were 28,628 CVD events. CVD risks across BP levels showed a “J-shape,” and were higher in men than women at all BP levels. The lowest risks were at SBP 100-105 mmHg (events per 10,000 person-years 95% CI: 15.6 11.8-19.4) and 110-115 (47.2 41.4-53.0) among women and men, respectively. Compared with SBP 100-110, sex-specific RRs at above 120 were higher in women than men, but RDs were higher in men than women at all levels of SBP. Compared to men at 110-115 (ie, the men with least risk), risks in women were lower at all levels of SBP below 170. Conclusions CVD risk is lowest for women at a slightly lower SBP than men and RRs for CVD increase with SBP at a slightly steeper rate in women. However, both risks and RDs in women are never greater than in men. This evidence does not support lower thresholds for diagnosis of hypertension in women.
Kelly et al. (2025) conducted a cohort in Cardiovascular disease (n=420,649). Systolic blood pressure vs. Sex differences (men vs women) was evaluated on Incident atherosclerotic cardiovascular disease. Systolic blood pressure associated with the lowest cardiovascular risk is lower in women (100-<105 mmHg) than men (110-<115 mmHg), but absolute risks in women never exceed those in men.