Prevalence and management of hypertension in acute coronary syndrome patients varies by sex: observations from the Sibrafiban versus aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) randomized clinical trials.
BACKGROUND
Hypertension affects 1 billion individuals worldwide and is an independent risk factor for death after acute coronary syndromes (ACS).


METHODS
We examined the prevalence and medical treatment of hypertension among 15,904 ACS patients randomized in the SYMPHONY and 2nd SYMPHONY trials. Analyses were performed overall and according to sex for the United States and across international practice. Multivariable models identified factors associated with use of antihypertensive medication classes and examined the association of hypertension and sex with mortality.


RESULTS
In the United States, hypertension was more prevalent in women than in men, overall (63% vs 50%) and within every decile of age. Hypertensive women more often received calcium-channel blockers (35% vs 30%) and diuretics (33% vs 19%) and less often received beta-blockers (51% vs 57%). Angiotensin-converting enzyme inhibitor use was similar (35% vs 34%). Women received multiple agents more frequently than did men: 2 agents, 35% vs 30%; > or = 3 agents, 16% vs 13%. Female sex independently predicted drug-class use only for diuretics. Mortality was higher in hypertensive women than in hypertensive men; after multivariable adjustment, mortality was similar without evidence of a differential association between hypertension and mortality according to sex. Although there was international variation in the use of individual classes of agents, the overall findings by sex were similar across regions.


CONCLUSIONS
Hypertension is more prevalent in women than in men with ACS, and its medical management varies by sex, but its association with mortality is similar. Opportunities exist to improve medical therapy and outcomes in women with hypertension.
Frazier
Camille G
CG
Duke University Medical Center, Clinical Research Institute, Durham, NC, USA.
Shah
Svati H
SH
Armstrong
Paul W
PW
Bhapkar
Manjushri V
MV
McGuire
Darren K
DK
Sadowski
Zygmunt
Z
Kristinsson
Arni
A
Aylward
Philip E
PE
Klein
Werner W
WW
Weaver
W Douglas
WD
Newby
L Kristin
LK
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012727:Sex Characteristics
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin