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Sex differences in cardiovascular outcomes in patients with incident hypertension

Daugherty, Stacie L.a,b; Masoudi, Frederick A.a,b; Zeng, Chanb; Ho, P. Michaela,b,c; Margolis, Karen L.d; O’Connor, Patrick J.d; Go, Alan S.e,f,g; Magid, David J.b,h

doi: 10.1097/HJH.0b013e32835bdc44

Background: The time of initial hypertension diagnosis represents an opportunity to assess subsequent risk of adverse cardiovascular outcomes. The extent to which women and men with newly identified hypertension are at a similar risk for adverse cardiovascular events, including chronic kidney disease (CKD), is not well known.

Methods: Among women and men with incident hypertension from 2001 to 2006 enrolled in the Cardiovascular Research Network (CVRN) Hypertension Registry, we compared incident events including all-cause death; hospitalization for myocardial infarction (MI), heart failure or stroke; and the development of CKD. Multivariable models were adjusted for patient demographic and clinical characteristics.

Results: Among 177 521 patients with incident hypertension, 55% were women. Compared with men, women were older, more likely white and had more kidney disease at baseline. Over median 3.2 years (interquartile range 1.6–4.8) of follow-up, after adjustment, women were equally likely to be hospitalized for heart failure [hazard ratio 0.90, 95% confidence interval (CI) 0.76–1.07] and were significantly less likely to die of any cause (hazard ratio 0.85, 95% CI 0.80–0.90) or be hospitalized for MI (hazard ratio 0.44, 95% CI 0.39–0.50) or stroke (hazard ratio 0.68, 95% CI 0.60–0.77) compared with men. Women were significantly more likely to develop CKD (9.60 vs. 7.15%; adjusted hazard ratio 1.17, 95% CI 1.12–1.22) than men.

Conclusion: In this cohort with incident hypertension, women were more likely to develop CKD and less likely to develop other cardiovascular outcomes compared with men. Future studies should investigate the potential reasons for these sex differences.

aDivision of Cardiology, University of Colorado Denver, Aurora

bInstitute for Health Research, Kaiser Permanente of Colorado, Aurora, Colorado

cVA Medical Center, Denver, Colorado

dHealthPartners Research Foundation, Minneapolis, Minnesota

eDivision of Research, Kaiser Permanente Northern California, Oakland

fDepartments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco

gDepartment of Health Research and Policy, Stanford University School of Medicine, Stanford, California

hSchool of Public Health, University of Colorado Denver, Aurora, Colorado, USA

Correspondence to Stacie Luther Daugherty, MD, MSPH, Division of Cardiology, University of Colorado Denver, 12605 E. 16th Avenue, Mailstop B130, P.O. Box 6511, Aurora, CO 80045, USA. Tel: +1 303 724 2089; fax: +1 303 724 2094; e-mail:

Abbreviations: BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; CVRN, Cardiovascular Research Network; eGFR, estimated glomerular filtration rate; ICD-9, International Classification of Diseases, 9th Revision; IQR, interquartile range; JNC7, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; MI, myocardial infarction

Received 17 May, 2012

Revised 12 October, 2012

Accepted 25 October, 2012

© 2013 Lippincott Williams & Wilkins, Inc.