Hypertension in Women: Recent Advances and Lingering Questions

Cardiovascular disease (CVD) is the leading cause of death in women in every major developed country and most emerging countries.1,2 Hypertension, the most common modifiable risk factor for CVD, is estimated to occur in 85.7 million adults in the United States (44.9 million women and 40.8 million men).3 Elevated blood pressure (BP) >140/90 mm Hg is associated with a shorter life expectancy overall, shorter life expectancy free of CVD, and more years lived with CVD.3–5 Hypertension is less common in women, compared with men, in those younger than 65 years of age, but is more common in elderly (65 years and older) women than men. In the United States, between 2011 and 2014, the prevalence of hypertension in women and men by age group was 8% versus 11% (20–34 years), 23% versus 23% (35–44 years), 33% versus 36% (45–54 years), 56% versus 58% (55–64 years), 66% versus 64% (65–74 years), and 81% versus 73% (≥75 years).3 Globally, the prevalence of hypertension differs between sexes. Mills et al6 conducted a systematic analysis of population-based studies from 90 countries with 968 419 individuals to estimate the prevalence of hypertension in various countries grouped by income. Women in middle-/low-income countries, across all age groups, had a higher prevalence of hypertension compared with high-income countries. Awareness rates were higher in women than in men in both high-income countries (72% women versus 62% men) and middle-/low-income countries (45% women versus 31% men). Furthermore, women in both high-income countries (62% women versus 49% men) and middle-/low-income countries (36% women versus 22% men) reported a higher rate of antihypertensive medication use compared with men, and hypertension control rates (BP <140/90 mm Hg) were higher in women than in men in both high-income countries (52% women versus 49% men) and middle-/low-income countries …