Sex Differences in Achieved Diastolic Blood Pressure and Cardiovascular Outcomes in Elderly Patients With Hypertension

Background

Blood pressure profiles differ in males and females. Low diastolic blood pressure (DBP) is associated with increased risk of cardiovascular disease (CVD). However, sex differences in achieved DBP and associated CVD risk remain unclear.

Objectives

The aim of this study was to examine sex differences in achieved DBP and CVD outcomes in elderly hypertensive patients.

Methods

This study is a secondary analysis of the STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial. The mean achieved DBP was compared between male and female participants. The association between mean achieved DBP and cardiovascular risk was evaluated as a continuous and categorical variable with a cubic spline model or Cox proportional hazards regression model.

Results

A total of 8,355 patients were included in this analysis. Median follow-up time was 3.08 years (Q1-Q3: 2.97-3.25 years). Female patients achieved lower DBP levels than male patients throughout the trial duration (P < 0.001), and in each treatment group (P < 0.05 for all). Mean achieved DBP exhibited a J-curve association with cardiovascular risk in females, but not in males. Both female and male patients showed increased cardiovascular risk at DBP >81 mm Hg (females: HR: 1.10; 95% CI: 1.03-1.16; males: HR: 1.06; 95% CI: 1.01-1.11). Mean achieved DBP of <65 mm Hg was associated with increased CVD risk only in female patients (females: HR: 2.33; 95% CI: 1.01-5.34; males: HR: 0.87; 95% CI: 0.12-6.25).

Conclusions

This study shows in elderly hypertensive patients, females have lower achieved DBP. A J-shaped relation between achieved DBP and CVD risk was observed in female, but not male patients. Low achieved DBP is associated with higher CVD risk among females but not males.