Hypertension is a Special Danger to Women

By George Spencer. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Heart disease, with high blood pressure as a key risk factor, is the leading cause of death among U.S. women. Younger women who have a heart attack and women without classic symptoms of a heart attack (no chest pain or pressure, for instance) tend to have poorer outcomes and mortality rates than men.

Women are also notably at risk of a heart attack because of the interplay between the female sex hormone estrogen and cholesterol levels. At the Wake Forest School of Medicine in Winston-Salem, N.C., researchers are looking into key connections between hormonal patterns and untreated high blood pressure, which is known as “hypertension.”

Numerous treatments and therapies already exist to combat hypertension. The most common ones involve lifestyle modifications through exercise and changes in diet, along with medications to lower blood pressure.

To date, treatment plans have been identical for men and women — even though women are more likely than men to die in the first year after a heart attack.

Maybe that’s not good enough anymore, says Carlos Ferrario, MD, professor of general surgery in the Office of Women in Medicine and Science at Wake Forest School of Medicine in North Carolina, and lead researcher of the study “Hemodynamic and Hormonal Patterns of Untreated Essential Hypertension in Men and Women.”

More Vascular Disease in Women

Wake Forest scientists examined variations in men’s and women’s hormones and noted “the varying hemodynamics,” or different forces involved in blood circulation between the sexes. These physiological differences may affect outcome, care and medications, too.

“We can now see a possible reason why [antihypertensive] medications are not as effective in women as they are in men,” says Ferrario. “We’ve known that hypertension is more severe in women than in men over the age of 64, and it’s more likely to be the cause of death among women in that age group.”

Even if men and women with hypertension have the same blood pressure readings, research finds that women’s arteries and other blood vessels are more damaged than men’s. What’s more, the severity of those injuries is clearly associated with the levels of male and female hormones associated with high blood pressure.

The study found an astonishing 30 to 40 percent more vascular disease in women who had the same high blood pressure levels as men.

Blocking the Activity of Dangerous Hormones

The hormone angiotensin II came under special scrutiny in these new studies. It increases blood pressure by constricting blood vessels and also directs the kidneys to retain salt and water.

Doctors found that women already have more of this hormone (angiotensin II) in their bodies, and because men and women are currently prescribed identical doses, women will continue to have higher, more dangerous levels than men will.

“Doctors need to prescribe compounds that block the activity of this hormone,” says Ferrario. “It will probably require higher doses in women than in men.” More research is necessary to determine whether different drugs or dosages of existing drugs become standard for women.

“To date, we have no guidelines and no real rationale for treating men and women differently,” says Ferrario. “We really need to look at existing therapies, look at the prescription drug dosages and treat women more aggressively, or at least differently, than men.”

Next Steps 

Although more research is needed, take these common-sense preventive steps:

  •  “Be more active in managing your own care. During post-menopause years, your risk of cardiovascular death is much higher than men’s,” says Ferrario. “Follow your doctor’s advice about exercising more, taking medications as prescribed and monitoring your own blood pressure.”
  • Women with hypertension should strive to lose weight, use salt sparingly, eat more fruits and vegetables (to boost potassium levels) and closely watch their intake of fats, say experts.

For Caregivers

  • Convince all your health care practitioners to be more aggressive in their management of hypertension, or high blood pressure, for the females in your life. “A real change is needed in attitudes regarding how to treat women,” says Ferrario. 

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