Gender-related differences in the management of arterial hypertension in women

In case of female patients, because of estrogens' protective influence, cardiovascular complications appear in average 10 years later than in case of men. Appropriately, problem of arterial hypertension in case of young and middle-aged population is also more pronounced in men than women. Nevertheless, after the menopause number of hypertensive women quickly rises and in the population of patients above 60 years old arterial hypertension is even more frequent in case of female than male gender. Guidelines for the non-pharmacological and pharmacological management of arterial hypertension, its classification and therapeutic goals are the same for the non-pregnant women as for the general population. According to the guidelines, each drug from the five main groups of antihypertensives can be used as a first choice treatment, the individual health status and concomitant disorders should be taken into consideration while deciding. In recent metaanalyses and most of the up to date large clinical trials no significant differences were found between sexes in the strength of hypotensive effect, neither in the risk reduction achieved with specified antihypertensive agents. Still the obvious anatomic and physiological differences between sexes cannot be disdained as they may have an impact on effectiveness and safety of the antihypertensive treatment. An important issue is also the age of a woman with hypertension. Theoretical premises exist, confirmed by results from singular clinical studies, that in case of women in their childbearing age the optimal treatment would be with the use of calcium channel blockers (because of their stronger in women than in men hypotensive effect) or beta-blockers (influencing the symphathetic activity - an important patophysiological pathway in case of young patients). Agents influencing the renin-angiotensin-aldosteron system such as angiotensin converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) can be used safely only together with effective contraceptive methods. In case of women after the menopause the best option seems to be monotherapy or polytherapy with: ACE-I or ARB (no negative impact on glucose or cholesterol level, positive influence on the heart and vessel wall remodeling, significant decrease in the number of complications), diuretics (to overcome the problem of fluid retention) and calcium channel blockers (good hypotensive effect, stronger in women than men). In women the risk of stroke is bigger than the risk of ischemic cardiac complications compared with the male population, though also mainly those three groups of drugs are indicated. There is a lack of properly designed, large clinical trials focused on the problem of gender-related differences in the effectiveness and safety of antihypertensive treatment. Accessible data origin mainly from metaanalyses and post-hoc analyses of the studies in which women are largely outnumbered by male patients.