Ao by linzhengnd


									Jeanette Strametz-Juranek

Women`s high blood pressure: do we treat women properly?

Hypertension is an important worldwide public-health challenge, the leading riskfaktor
for cardiovascular and kidney diseases and ranked third as cause of disability-
adjusted life-years in women and men.
However, there are major genderspecific differences in prevalence, pathophysiology,
awareness and treatment of hypertension. After menopause the incidence and
prevalence of hypertension is markedly increasing in women. Before menopause
endogenous estrogens seems to protect the endothelium, but after menopause, the
continous decline of estrogens is a associtaed with a marked increase of
vasoconstrictors such as Endothelin, Angiotensin, leading to subsequent stiffness
and vasoconstriction in the endothelium. Further is comes to an activation of the
symphatetic nerve activity, increased insulin resistance, weight gain and salt
sensitivity all leading to hypertension in postmenopausal women. Also in treatment of
hypertension are genderspecific differences. In a recent study in Sweden it has been
shown that women are less treated with ACE-inhibitors/AT-II-receptor-blockers and
receive more beta-blockres and diuretics. Furthermore, they received less statins to
minimize their cardiovascular risk.
In most hypertension guidlines „sex and gender“ are not included, so women and
men right now have the same treatment goals in hypertension, not emphazining that
the cardiovascular risk is markeldy increasing in postmenopausal women.
In future more women have to be included in large clinical trials, focusing on the
specific role of estrogens, estrogen receptors, salt sensitivity and optimal blood
pressure target values in the female population to fight against the increasing
hypertension-associated morbodity and mortality in women.

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