Sex differences in the association between systolic blood pressure control and clinical outcomes in working-age adults
K Takegawa, K Kanaoka, S Kawabata, H Matsuura, Y Iwanaga, T S Sasano, Y MiyamotoAbstract
Background
Hypertension is a major cardiovascular risk factor, and current guidelines recommend a target systolic blood pressure (SBP) control of <130 mmHg. However, sex differences in the association between achieving SBP control and clinical outcomes among working-age adults remain unclear.
Purpose
To examine sex differences in the association between achieving SBP <130 mmHg and clinical outcomes among working-age adults with hypertension.
Methods
We identified patients with SBP ≥140 mmHg at the index health check-up and initiated antihypertensive medication between April 2015 and March 2022. Patients were classified according to whether they achieved SBP <130 mmHg at the second health check-up. The primary outcome was a composite of all-cause death, acute myocardial infarction, stroke, and heart failure hospitalization. We examined sex-specific associations between achieving SBP<130 mmHg and the primary outcome using inverse probability of treatment weighting.
Results
Among the 55,830 participants, the mean age was 52±9 years, and SBP at the index health check-up was 155±14 mmHg. Of these, 17,513 were female, and 38,317 were male. Target achievement was observed in 10,163 (58%) and 22,573 (59%), respectively. In the female cohort, the incidence rates were 1.17 versus 1.22 per 100 person-years (target achievement versus no target achievement); in the male cohort, 1.72 versus 2.08 per 100 person-years. After adjustment, achieving target SBP was not associated with a lower risk of the primary outcome in the female cohort (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.79–1.12). In contrast, in the male cohort, achieving target SBP was associated with a lower risk of the primary outcome compared with not achieving target SBP (HR: 0.85, 95% CI: 0.78–0.93).
Conclusions
Among working-age adults, achieving SBP <130 mmHg was associated with a lower risk of clinical outcomes in males but not in females. The findings suggest that optimal SBP targets may need sex-specific consideration.Figure1