Sex specific associations between blood pressure in midlife and left ventricular hypertrophy in older women and men
E Kringeland, H Midtbo, R Shigdel, A E Ohldieck, H Halland, A Selmyte Besuspare, B N Herfindal, E GerdtsAbstract
Background
Women with hypertension have higher prevalence of left ventricular hypertrophy (LVH) than men. It is not known whether blood pressure (BP) in midlife carries a different risk of LVH later in life for women and men.
Purpose
Our aim was to assess sex specific associations between BP categories in midlife and LVH later in life
Methods
We tested associations between BP at age 42 (baseline) with LVH 26 years later (follow-up) among 1,170 women and 956 men participating in the population-based Hordaland Health study. Participants were grouped by baseline BP category: Normotension (BP < 130/80 mmHg), stage 1 (BP 130-139/80-89 mmHg) and stage 2 hypertension (BP ≥140/90 mmHg). LVH was identified by echocardiography as left ventricular mass/height2,7 exceeding sex-specific thresholds. Associations between BP category and LVH were assessed in sex-specific logistic regression analyses, with normotension as the reference category. Results are reported as odds ratios (OR) with 95% confidence intervals (CI).
Results
At baseline, a lower proportion of women than men had stage 1 and 2 hypertension, respectively, (24 vs. 35% and 10 vs. 27%, P < 0.001). At follow-up, 8% of women and 11% of men had LVH (P =0.04). In unadjusted analysis, both stage 1 and stage 2 hypertension were associated with LVH in women, OR 2.40 (95% CI 1.53-3.77) and OR 2.00 (1.04-3.82) but not in men OR 1.00 (95% CI 0.62-1.62) and OR 1.21 (95% CI 0.74-2.00). After adjustment for baseline diabetes, smoking, serum-total-cholesterol, and body mass index, stage 1 hypertension remained associated with LVH in women (OR 2.00 [95% CI 1.26-3.18]) while the association between stage 2 hypertension and LVH was attenuated (OR 1.38 (0.68-2.78]), reflecting the importance of concomitant overweight. In men the associations between baseline BP and LVH remained non-significant also in multivariable analyses (both p>0.05). A significant interaction between BP categories and sex confirmed that these associations differed between women and men.
Conclusion
Among individuals in their early 40s, stage 1 hypertension was a strong risk factor for LVH later in life in women, but not in men. These results add to the increasing body of evidence documenting that even mildly elevated BP in midlife promotes organ damage in women.Figure 1For image description, please refer to the figure legend and surrounding text.