Sex-specific links between midlife BP and arterial stiffness after 27 years
Overview
This study from the Hordaland Health Study found that elevated blood pressure or hypertension in early midlife significantly increased the risk of arterial stiffness 27 years later in women but not in men. Women with elevated BP had nearly threefold, and those with hypertension over fourfold, higher odds of increased arterial stiffness compared to women with non-elevated BP.
Background
Hypertension is a well-established risk factor for cardiovascular disease (CVD), with evidence suggesting women may be more vulnerable to its effects than men. Prior research indicates that women develop CVD at lower blood pressure thresholds and have higher prevalence of hypertension-related organ damage. Arterial stiffness, a marker of vascular aging and organ damage, is a predictor of future CVD events. However, sex-specific long-term associations between midlife blood pressure and arterial stiffness remain unclear.
Data Highlights
Parameter
Women (n=1127)
Men (n=938)
P-value
Elevated BP at baseline (%)
62
67
<0.001
Hypertension at baseline (%)
9
26
<0.001
Increased arterial stiffness at follow-up (%)
17
31
<0.001
Adjusted OR for increased stiffness with elevated BP (women)
2.78 (1.74–4.42)
1.10 (0.58–2.10)
0.01 (sex interaction)
Adjusted OR for increased stiffness with hypertension (women)
4.62 (2.48–8.58)
1.33 (0.67–2.66)
0.01 (sex interaction)
Key Findings
At baseline (mean age 42), 62% of women and 67% of men had elevated BP; 9% of women and 26% of men had hypertension.
After 27 years, 17% of women and 31% of men exhibited increased arterial stiffness (cf-PWV > 10 m/s).
Women with elevated BP had 2.78 times higher odds of increased arterial stiffness compared to women with non-elevated BP.
Women with hypertension had 4.62 times higher odds of increased arterial stiffness compared to women with non-elevated BP.
No significant association between baseline BP categories and arterial stiffness was observed in men.
There was a significant sex interaction (P=0.01) indicating the relationship between midlife BP and later arterial stiffness differs by sex.
Clinical Implications
These findings highlight the importance of early identification and management of elevated blood pressure in women during midlife to prevent long-term vascular damage. Clinicians should consider sex-specific risk when evaluating BP and cardiovascular risk, as women may develop arterial stiffness and subsequent CVD at lower BP thresholds than men. Early intervention in women with elevated BP could improve cardiovascular outcomes.
Conclusion
Elevated blood pressure and hypertension in early midlife are strong predictors of increased arterial stiffness nearly three decades later in women but not in men, underscoring the need for sex-specific cardiovascular risk assessment and management strategies.
References
Hordaland Health Study (2024) -- Gender-specific relationships between early midlife blood pressure and arterial stiffness after 27 years
