Sex differences in blood pressure response to antihypertensive therapy in Chinese patients with hypertension.
BACKGROUND
Sex-specific responses to antihypertensive drugs are not very well understood.


OBJECTIVE
To investigate sex-related differences in blood pressure response to antihypertensive drugs in a community-based prospective clinical trial.


METHODS
We recruited 3535 untreated hypertensive patients (2326 women), aged 40-75 years, from 7 rural communities in China. Subjects were randomized to 1 of 4 drug groups: atenolol, hydrochlorothiazide (HCTZ), captopril, or sustained-released nifedipine; duration of the study was 8 weeks. Mean blood pressure reduction, blood pressure control rates, and frequency of adverse events were compared between men and women.


RESULTS
Women had a better response to HCTZ in relation to diastolic blood pressure (1.8 mm Hg lower) than did men (p < 0.05) and were 57% more likely to reach the control goal of diastolic blood pressure than were men (p < 0.05). In the atenolol group, mean systolic blood pressure decreased 3.9 mm Hg more in women than in men (p < 0.05), and women were 65% more likely to reach the control goal of systolic blood pressure and 57% more likely to reach the control goal of diastolic blood pressure than were men (p < 0.05). Significant sex-related differences were also found in drug-related adverse events in the nifedipine group (15.8% in women vs 9.8% in men; p = 0.017) and in the captopril group (14.3% in women vs 8.4% in men; p = 0.005), but no differences were seen with HCTZ or atenolol.


CONCLUSIONS
Women have better blood pressure responses to HCTZ and atenolol and experience more adverse effects with sustained-release nifedipine and captopril than do men, indicating that sex should be taken into account when selecting antihypertensive drugs.
Fan
Xiaohan
X
Department of Cardiology, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Han
Yunfeng
Y
Sun
Kai
K
Wang
Yibo
Y
Xin
Ying
Y
Bai
Yongyi
Y
Li
Weiju
W
Yang
Tao
T
Song
Xiaodong
X
Wang
Hu
H
Fu
Chunyan
C
Chen
Jingzhou
J
Shi
Yi
Y
Zhou
Xianliang
X
Wu
Haiying
H
Hui
Rutai
R
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000494:pharmacology*; D044466:Asian People; D001262:Atenolol / Q000009:adverse effects / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D002216:Captopril / Q000009:adverse effects / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000494:pharmacology; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000009:adverse effects / Q000494:pharmacology; D011446:Prospective Studies; D012737:Sex Factors
D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D006852:Hydrochlorothiazide; D001262:Atenolol; D002216:Captopril; D009543:Nifedipine