The relationship between achieved blood pressure values and cardiovascular risk in women and men during antihypertensive treatment
Authors: Sobieraj P , Gerdts E , Kringeland E , De Simone G 
Published: October 2022

Abstract

Introduction
There is limited knowledge about sex differences in effect from clinical studies of blood pressure (BP) reduction.

Purpose
To evaluate the associations between achieved BP and outcome in the Systolic BP Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD BP) trials in sex-specific analyses.

Methods
Data of 9361 SPRINT and 4773 ACCORD BP trials participants were analysed separately. In both trials participants were randomly assigned 1:1 to the treatment goal (SBP &lt;120 vs &lt;140 mm Hg). SPRINT was performed in subjects without diabetes mellitus type 2 (DM2) while all ACCORD BP participants had DM2. In-trial SBP and DBP were computed as mean of all measurements obtained during the trials. The composite clinical endpoint (CE) was defined as combined myocardial infarction, stroke, hospitalization due to heart failure and death from cardiovascular disease (CVD). Cox proportional hazard risk models were used to evaluate the relationship between CE risk and SBP and DBP, respectively, adjusting for age, ethnicity, current smoking, body mass index, total serum cholesterol and glucose separately for each sex.

Results
Females (N=3332) enrolled in SPRINT were older than men (68.5±9.5 vs 67.6±9.3 years, p&lt;0.001), and had higher SBP (141.2±16.8 vs 138.8±14.8 mm Hg, p&lt;0.001) and lower DBP (77.6±12.1 vs 78.4±11.8 mm Hg, p=0.004) at baseline, and less often known CVD (15.3% vs 22.7%, p&lt;0.001), but more often reported chronic kidney disease (CKD) (31.8% vs 26.3%, p&lt;0.001), while smoking did not differ. Females obtained higher in-trial SBP and lower in-trial DBP than males (129.9±10.5 vs 129.2±9.5, p=0.0012, and 71.9±9.1 vs 72.3±9.4 mm Hg, p=0.038), respectively.
Compared to males, females (N=2258) participating in ACCORD BP less often had known CVD (25.8% vs 40.8%, p&lt;0.001) or CKD (34.4% vs 38.4%, p&lt;0.001), less frequently smoked (9.8% vs 13.2%, p&lt;0.001), had higher SBP (140.1±16.7 vs 138.4±14.9 mm Hg, p&lt;0.001) and similar DBP (76.1±10.3 vs 75.9±10.5 mm Hg, p=0.51) at baseline, while age did not differ (62.8±6.4 vs 62.7±6.9 years, p=0.829). In-trial SBP and DBP were higher among females (128.5±11.8 vs 127.6±10.3 mm Hg, p=0.006, and 69.5±7.9 vs 68.8±8.2 mm Hg, p=0.001), respectively. Both in SPRINT and ACCORD BP trials female sex was associated with lower CE rate (hazard ratio for CE in SPRINT 0.72, 95% CI 0.60–0.86, p&lt;0.001 and in ACCORD BP 0.74, 95% CI 0.62–0.87, p&lt;0.001; respectively). The relationship between in-trial SBP and CE among SPRINT participants is presented in Figure 1. In ACCORD BP a stronger relationship between in-trial SBP and CE was found in females than in males (Figure 2).

Conclusions
The characteristics of females enrolled in clinical studies in hypertension are different from that of males. Better outcome was observed in females. Achieved SBP was stronger associated with outcome in women than in men only when DM2 comorbidity was present.

Funding Acknowledgement
Type of funding sources: None.