Physicians' Academy for Cardiovascular Education

Faster rates of BP elevation with aging in women vs. men

Sex Differences in Blood Pressure Trajectories Over the Life Course

Literature - Ji H, Kim A, Ebinger JE, et al. - JAMA Cardiol.2020, doi:10.1001/jamacardio.2019.5306

Introduction and methods

Differences between women and men in the manifestation of CVD are that in women onset of CVD is delayed and symptoms are atypical compared to men. Also, women are more likely to develop coronary microvascular dysfunction and HF with preserved ejection fraction (HFpEF), especially in the presence of hypertension [1-3]. Clinical experience and data now suggest that CV pathophysiology is different between women and men.

Sex differences in earlier-life CV physiology were examined to see whether they precede differences in later-life CV pathophysiology. Population-based multicohort data was used to analyze blood pressure (BP) trajectories during life time. Elevation in BP was chosen as this represent the single most accessible measure of vascular aging and largest contributor to ischemic heart disease and HF [4,5].

Longitudinally collected BP measurements from 4 community cohort were used: the Framingham Heart Study (FHS) offspring cohort, the Atherosclerosis Risk in Communities (ARIC) Study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, and the Multi-Ethnic Study of Atherosclerosis (MESA). A total of 32 833 unique participants were enrolled, 54% were women. 144,599 measurements were included over a time span of 43 years (1971-2014) with age of participants ranging from 5 to 98 years.

In the setting of antihypertensive therapy, 10 mmHg was added to SBP and 5 mmHg to DBP value s to account for treatment effects of antihypertensive therapy on BP. Incident hard CVD was defined as new-onset fatal or nonfatal myocardial infarction, HF or stroke.

Main results


An analysis of BP data of >32,000 individuals in communities showed that BP elevations increased more rapidly in women than in men, suggesting that vascular changes develop earlier and progress faster in women. These vascular changes may precede differences in later-life CV pathophysiology and may explain why CVD tends to present differently between sexes.


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