Women Face Challenges In Controlling Hypertension
Some Need More Medications Than Men
Researchers report that women have a greater burden
of hypertension than their male counterparts and they receive more aggressive
treatment for it, yet they obtain no better blood pressure control.
In addition, the
researchers say that the impact of hypertension on mortality or
recurrent cardiac events was similar between men and women.
Reporting their findings at the annual scientific session
of the American Heart Association, the Duke University
scientists say there are great opportunities to improve medical
therapy and outcomes in women.
Cardiologist Kristin
Newby, of the Duke Clinical Research Institute, wanted to know how the
prevalen ce
and treatment of hypertension varied between the sexes in patients who
came to the hospital with an acute coronary syndrome (ACS). ACS occurs
when a patient arrives at the hospital with chest pain and physicians
must determine whether or not the symptoms are due to unstable angina
or signal a real heart attack.
"Hypertension has been proven to be an independent risk
factor for death or further cardiac events after ACS," Dr. Newby explains.
"There is little doubt that hypertensive women with ACS are at a higher
unadjusted risk for death or heart attack, but when you statistically
adjust for such factors as age, kidney function, diabetes, or other
heart problems, the risks turn out to be about the same.
"The difference in outcomes does not appear to be due
totally to gender, but at least in part to these and other factors,"
Dr. Newby says.
Dr. Franz Messerli of the Ochsner Clinic Foundation
Hospital in New Orleans, says, "It's harder for women to get to the
goals [normal blood pressure readings], but despite that, women do remarkably
well."
An encouraging finding, Dr. Messerli says, is that even
though women received intense antihypertensive therapy and were not
as well-controlled as men, "their outcomes are about the same."
Researchers
Look at Data from Earlier Studies
To conduct the study, Dr. Newby consulted data gathered
from two related international trials - SYMPHONY and 2nd SYMPHONY (Sibrafabin
vs. aspirin to yield maximum protection from ischemic heart events post-acute
coronary syndromes).
While these trials were designed to compare the effectiveness
of aspirin to a new class of drugs that dissolves blood clots, researchers
at the 931 participating centers also collected data on each patient's
medication history and outcomes.
Dr. Newby's analysis included 2,091 women and 5,084
men enrolled in the SYMPHONY trials in the US. She found that 63 percent
of women had hypertension, compared to 50 percent of the men. The women
with hypertension tended to be older, had reduced kidney function, and
more often had diabetes and a history of heart failure when compared
to men.
However, women had fewer previous heart attacks
or invasive procedures to improve blood flow to the heart.
"What we found so interesting was that women received
more and different agents to reduce blood pressure than did the men,"
Dr. Newby said. "What is confusing is that this difference in the number
of drugs to control hypertension still did not have any significant
effect, when compared to the men."
The classes of medications used most often to control
blood pressure were ACE inhibitors, beta-blockers, calcium channel blockers,
and diuretics.
Specifically, 16 percent of the women were prescribed
three different medications to control hypertension, compared to 13
percent for men. Almost 35 percent of women received two different medications,
compared to 30 percent for men.
Only one type of medication, diuretics, appeared
to be prescribed to women more often than to men - 33 percent in women
compared to 19 percent in men.
"While women were more likely to get multi-drug treatments,
they still had higher blood pressures," Dr. Newby says. Systolic
pressure was 150 millimeters of mercury (mmHg) at presentation in women
and 147 mmHg in men, she reports.
Even after treatment for the ACS, blood pressure remained
higher in women (126 mmHg vs. 124 mmHg in men).
Finding
Best Treatment for Women a Goal
"Thus, it is not clear if women are not getting the
right medicines, are getting them in the wrong doses, or if other factors
are responsible for the need for more medications in women to attain
similar control," Dr. Newby says.
Dr. Newby says that physicians need to be aggressive
in treating hypertension, whether their patients are male or female.
She added that awareness of the disease, both on the part of physicians
and patients, is important to reducing the prevalence of hypertension
and therefore reduce the risk for heart attacks.
"Hypertension is often forgotten about, a silent disease,"
she says. "Awareness may be the key, since the disease itself does not
make patients feel bad. A lack of awareness affects compliance with
medications, going to the doctor for check-ups, eating healthful meals,
all those things that are helpful in keeping hypertension in control."
Always consult your physician for a diagnosis.
Online
Resources
American
Heart Association
American
Society of Hypertension
Centers
for Disease Control and Prevention (CDC)
HealthierUS.Gov
National
Institutes of Health (NIH)
National
Women's Health Information Center
Office
of Research on Women's Health |
January
2004
In
This Issue:
Women
Face Challenges In Controlling Hypertension
Researchers
Look at Data from Earlier Studies
Finding
Best Treatment for Women a Goal
Blood
Pressure Explained
Heart
Attack In Women
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Women's
Services at St. John's Mercy
Women's
Health Information
St.
John's Mercy Classes and Programs
Blood
Pressure Explained
Blood pressure, measured with a blood pressure cuff
and stethoscope by a nurse or other healthcare provider, is the force
of the blood pushing against the artery walls.
Each time the heart beats, it pumps blood into the arteries,
resulting in the highest blood pressure as the heart contracts.
An electronic blood pressure monitoring device may
be used when an individual takes his/her own blood pressure. Electronic
blood pressure monitors may also measure the heart rate, or pulse.
Two numbers are recorded when measuring blood pressure.
The higher number, or systolic pressure, refers to the pressure inside
the artery when the heart contracts and pumps blood through the body.
The lower number, or diastolic pressure, refers to the
pressure inside the artery when the heart is at rest and is filling
with blood. Both the systolic and diastolic pressures are recorded as
"mmHg" (millimeters of mercury). This recording represents how high
the mercury column is raised by the pressure of the blood.
High blood pressure, or hypertension, directly increases
the risk of coronary heart disease (heart attack) and stroke (brain
attack). With high blood pressure, the arteries may have an increased
resistance against the flow of blood, causing the heart to pump harder
to circulate the blood.
According to the National Heart, Lung, and Blood
Institute (NHLBI) of the National Institutes of Health
(NIH), high blood pressure for adults is defined as:
140 mmHg or greater systolic pressure
and
90 mmHg or greater diastolic pressure
In an update of NHLBI guidelines for
hypertension in 2003, a new blood pressure category was added called
prehypertension:
120 mmHg – 139 mmHg systolic pressure
and
80 mmHg – 89 mmHg diastolic pressure
The new NHLBI guidelines now define
normal blood pressure as follows:
Less than 120 mmHg systolic pressure
and
Less than 80 mmHg diastolic pressure
These numbers should be used as a guide only. A single
elevated blood pressure measurement is not necessarily an indication
of a problem.
A physician will want to see multiple blood pressure
measurements over several days or weeks before making a diagnosis of
hypertension (high blood pressure) and initiating treatment.
Always consult your physician for more information.
Heart
Attack In Women
It is a myth that heart disease is a man's disease.
In fact, cardiovascular diseases are the number one killer of women.
These diseases currently claim the lives of more than
a half a million females every year - more than the next 16 causes of
death combined.
In 64 percent of women who died suddenly from cardiovascular
disease, there were no previous symptoms of the disease.
According to the the American Heart Association:
Forty-one percent of all deaths in women occur
from cardiovascular disease.
In the US, cardiovascular diseases claim the lives of
nearly 506,000 women annually, while all forms of cancer combine
to kill about 267,000 women.
Coronary heart disease is the single largest cause of
death for women in the US.
About 18,900 women under age 65 die of coronary
heart disease each year; about 35 percent of them are under age 55.
Always consult your physician for more information.
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