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Gender Differences in Hypertension

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Abstract

Hypertension is the leading risk factor for global mortality and morbidity and remains the major preventable cause of cardiovascular diseases. Gender differences in risk factors and awareness, treatment, and control of hypertension have been well established in humans. There are significant differences in epidemiology and clinical characteristic of hypertension between men and women. Moreover, gender differences are linked with several specific types of hypertension, including postmenopausal hypertension, white coat hypertension, masked hypertension, and hypertensive disorders of pregnancy. Gender differences have been implicated in the prevalence and determinants of hypertension and prehypertension whereas the control rate is similar between men and women taking antihypertensive medication. Importantly, distinct roles of the angiotensin-converting enzyme 2/Apelin signaling, sex hormone, endothelin-1, and sympathetic nervous activity contribute to sex differences in blood pressure control. This review summarizes gender differences in clinical features and determinants of hypertension and the underlying mechanisms responsible for hypertension.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACC:

American College of Cardiology

ACE:

Angiotensin-converting enzyme

ACE2:

Angiotensin-converting enzyme 2

ACEI:

Angiotensin-converting enzyme inhibitor

AHA:

American Heart Association

Ang-(1–7):

Angiotensin 1–7

AngII:

Angiotensin II

ARB:

Angiotensin receptor blocker

AT1:

Angiotensin II type 1 receptor

AT2:

Angiotensin II type 2 receptor

BP:

Blood pressure

CCB:

Calcium channel blockers

CVD:

Cardiovascular diseases

DBP:

Diastolic blood pressure

ESC:

European Society of Cardiology

ESH:

European Society of Hypertension

ET-1:

Endothelin-1

LIFE:

The Losartan Intervention For Endpoint Reduction in Hypertension Study

MH:

Masked hypertension

NO:

Nitric oxide

NHANES:

National Health and Nutrition Examination Survey

RAS:

Renin-angiotensin system

SBP:

Systolic blood pressure

SNA:

Sympathetic nervous activity

WCH:

White coat hypertension

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Correspondence to Jiu-Chang Zhong.

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Song, J., Ma, Z., Wang, J. et al. Gender Differences in Hypertension. J. of Cardiovasc. Trans. Res. 13, 47–54 (2020). https://doi.org/10.1007/s12265-019-09888-z

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Keywords

  • Hypertension
  • Gender difference
  • Renin-angiotensin system
  • Sex hormone
  • Endothelin-1
  • Immune system