Physicians' Academy for Cardiovascular Education

CVD risk associated with lower SBP range in women than in men

Sex Differences in Blood Pressure Associations With Cardiovascular Outcomes

Literature - Ji H, Niiranen TJ, Rader F et al., - Circulation. 2021 Feb 16;143(7):761-763. doi: 10.1161/CIRCULATIONAHA.120.049360.

Introduction and methods

A systolic blood pressure (SBP) of 120 mm Hg has long been considered the normal upper limit in adults. Epidemiologic findings have shown that CVD risk continuously increases with increasing SBP starting at 120 mm Hg [1]. Although it is known that adult BP levels are on average lower in women than in men [2], it remains uncertain whether a lower SBP range should be considered as normal in women compared to men. This study investigated sex differences in BP associations with CV outcomes.

Data from standardized SBP measurements from 27542 subjects (54% women) without CVD at baseline from four community-based cohort studies (the Framingham Heart Study, Multi-Ethnic Study of Atherosclerosis, Atherosclerosis Risk in Communities Study, and Coronary Artery Risk Development in Young Adults Study) were analyzed. Age and race distributions were similar between men and women. A total of 7424 participants (44% women) developed non-fatal or fatal CVD during a follow-up of 28±12 years. This involved 3405 MI events, 4081 HF events and 1901 stroke events. SBP was stratified into categories of 10 mm Hg increments from <100 mm Hg to ≥160 mm Hg. SBP categories were related with incident CVD using cohort-stratified Cox proportional hazards models. Competing risks were accounted for and HR’s were adjusted for traditional risk factors.

Main results


Increased CVD risk is associated with lower SBP ranges in women compared to men. These results suggest that the definition of an optimal SBP may need to be sex-specific. Further studies are needed for the validation of these results and prospective studies are necessary to determine whether treatment targets for hypertension medication should be lower for women compared to men.


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Find this article online at Circulation.

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