Sex Differences in Blood Pressure Variability, Office-Home Difference, and Hypertension-Mediated Organ Damage: A Multicenter Analysis.

Abstract

Background: Sex differences in blood pressure (BP) regulation may modify associations between BP variability (BPV) and hypertension-mediated organ damage (HMOD), but organ-specific effects remain unclear.

Methods: We studied 398 hypertensive patients from a multicenter home BP monitoring registry. The office-home BP difference (ΔBP = office-home) was analyzed as a single continuous exposure variable, with positive values indicating the white-coat effect and negative values indicating the masked effect. Multivariable regression examined sex-specific associations of BPV patterns with HMOD, including electrocardiographic left ventricular hypertrophy (ECG-LVH) and microalbuminuria/proteinuria.

Results: Women demonstrated higher home systolic BPV than men despite similar mean BP levels (P < .01). Office BP was the primary determinant of white-coat phenotypes (office SBP: adjusted odds ratio [aOR] 1.29 [95% CI: 1.22-1.37]; office DBP: aOR 1.27 [1.19-1.37], both P < .01), while home BP predicted masked phenotype (home SBP: aOR 1.23 [1.12-1.39]; home DBP: aOR 1.34 [1.23-1.48], both P < .01). White-coat effects showed protective associations with total HMOD (systolic aOR 0.97 [0.94-1.00], P < .05), while office BPV demonstrated consistent positive associations (systolic aOR 1.10 [1.05-1.16]; diastolic aOR 1.12 [1.05-1.20], both P < .01). Critically, significantly sex interaction emerged for ECG-LVH, while microalbuminuria/proteinuria showed consistent associations across sexes.

Conclusions: Sex fundamentally modifies BP patterns-HMOD relationships in an organ-specific manner. Cardiac target organ damage requires sex-attentive monitoring approaches, while renal damage shows universal associations with office BPV. These findings support precision medicine approaches to hypertension management incorporating sex-specific BP assessment strategies.