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Hypertension in Women: What is Really Known?
The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine*
- Kathryn Anastos, MD;
- Pamela Charney, MD;
- Rita A. Charon, MD;
- Ellen Cohen, MD;
- Clara Y. Jones, MD;
- Carola Marte, MD;
- Deborah M. Swiderski, MD;
- Mary E. Wheat, MD; and
- Sarah Williams, MD
Abstract
▪ Purpose: To determine whether there is sufficient information in the medical literature to guide appropriate treatment of hypertensive women.
▪ Data Identification: Epidemiologic surveys of hypertension, clinical trials of antihypertensive therapy, and studies of selected adverse effects of antihypertensive agents were identified through a computerized search using MEDLINE and by identifying all studies cited in current medical textbooks as supporting evidence for the guidelines for the treatment of hypertensive individuals. All epidemiologic studies selected were cross-sectional or longitudinal, multicenter, population-based surveys. All clinical trials were large, randomized studies comparing one or more antihypertensive agents with a placebo or nonplacebo control group. Epidemiologic studies and clinical trials were reviewed to assess the quantity and quality of information available regarding important aspects of hypertension in women. Data pertaining to epidemiology, natural history, results of treatment, and two significant side effects of antihypertensive treatment were examined.
▪ Results of Data Analysis: The prevalence of hypertension is greater in black women than in black men and is about equal in white women and men. Because women outnumber men in the population, there are more hypertensive women than men. The attributable risk percent (the proportion of end points that could be eliminated by removing hypertension) for cardiovascular complications of hypertension is higher for women than men. Clinical trials show clear benefit of therapy for black women but no clear benefit for white women; some studies suggest that treatment of white women is harmful. Lipid profiles and their relation to ischemic heart disease differ for women and men; there is currently no information on the effects of antihypertensive agents on serum lipids in women. Few data have been published on the frequency of sexual dysfunction in treated hypertensive women.
▪ Conclusions: Hypertension in women and its related cardiovascular outcomes are a major public health problem. Clinical trials of antihypertensive therapy do not fully support current guidelines for the treatment of hypertensive women. Research concerning adverse effects of antihypertensive agents has largely excluded women from consideration; further studies are required to guide appropriate treatment.
Article and Author Information
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From Bronx-Lebanon Hospital Center; Bronx Municipal Hospital Center; Columbia-Presbyterian Medical Center; Montefiore Medical Center, North Central Bronx Hospital, Beth Israel Medical Center, and New York University Medical Center; New York, New York. For current author addresses, see end of text.
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↵* This work was a collaborative effort with equal participation by all members of the working group. Authors are listed in alphabetical order.
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Requests for Reprints: Ellen Cohen, MD, Department of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467.
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Current Author Addresses: Dr. Anastos: Bronx Lebanon Hospital Center, 1309 Fulton Avenue, Bronx, NY 10456.
Dr. Charney: Bronx Municipal Hospital Center, Primary Care Clinic, 3 North 31, Pelham Parkway and Eastchester Road, Bronx, NY 10461.
Dr. Charon: Columbia-Presbyterian Medical Center, 630 West 168th Street, New York, NY 10032.
Drs. Cohen, Jones, Swiderski, and Wheat: Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467.
Dr. Marte: Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003.
Dr. Williams: Department of Medicine, New York University Medical Center, 16 South, 550 First Avenue, New York, NY 10016.
- © 1991 American College of Physicians
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