Hypertension in women

Hypertension is a major contributor to both atherosclerotic cardiovascular disease (CVD) and heart failure among women, contributing substantially to women’s morbidity and mortality. There are significant racial and ethnic disparities with the greatest prevalence of hypertension, as well as hypertensive disorders of pregnancy, among Black women. There are substantial differences in the underlying pathophysiology and the prevalence, awareness, and treatment of hypertension between women and men. Women have unique considerations throughout their life course that influence blood pressure and/or its treatment. These include the use of oral contraceptives, female-specific conditions such as polycystic ovary syndrome, female-predominant conditions such as autoimmune disease and fibromuscular dysplasia, infertility treatment, pregnancy, menopause, and menopausal hormone therapy. Assessment of a comprehensive reproductive history can help identify these unique female-specific risk-enhancing factors, so that appropriate prevention and treatment can be implemented. Treatment of hypertension can reduce the risk of CVD in women. Healthy lifestyle and nonpharmacologic interventions are effective in reducing blood pressure in women. Furthermore, clinical trial data have shown similar efficacy of antihypertensive treatment for reducing major adverse cardiovascular outcomes for both women and men without effect modification by sex. However, women are less likely to be enrolled in cardiovascular clinical trials and less likely to be treated according to guideline recommendations. Improving the diagnosis, awareness, treatment, and control of hypertension throughout a woman’s lifespan is critical for reducing cardiovascular risk.