Gender differences in the treatment of hypertension: a community based study in Porto.

OBJECTIVES

To describe the use of antihypertensive drugs in a random sample of adults living in Porto, Portugal, and to identify gender differences in the treatment of hypertension.

DESIGN

Observational, cross-sectional.

PARTICIPANTS AND METHODS

Nine hundred and fifty-nine participants over 39 years of age, living in Porto, were selected by random digit dialing. For each subject, socioeconomic characterization, family and personal medical history, and information on antihypertensive treatment were obtained through a questionnaire. Blood pressure was measured on a single occasion, and a fasting blood sample was collected. Gender differences in the treatment of arterial hypertension and number and type of drugs were evaluated through the calculation of female:male proportion ratios and 95% confidence intervals (95% CI).

RESULTS

Hypertension treatment was more frequent in women than in men (proportion ratio 1.40, 95% CI 1.15-1.72), although no differences were observed among hypertensives aware of their condition (proportion ratio 1.07, 95% CI 0.93-1.22). The female:male proportion ratios of treatment with one drug, fixed combination therapy and free combination therapy were 1.13 (95% CI 0.94-1.36), 0.83 (95% CI 0.34-2.01) and 0.76 (95% CI 0.49-1.19), respectively. In subjects treated with one drug the use of ACE inhibitors/AT-II antagonists was more frequent in men (proportion ratio 0.68, 95% IC 0.46-1.01) and treatment with diuretics higher in women (proportion ratio 1.83, 95% CI 1.04-3.23). In participants treated with combination therapy, ACE inhibitors/AT-II antagonists and diuretics were more frequently used by women and calcium channel blockers and beta-blockers by men (female:male proportion ratios were 1.27, 95% CI 0.96-1.68, 1.24, 95% CI 0.94-1.64, 0.61, 95% CI 0.37-1.02 and 0.74, 95% CI 0.31-1.79, respectively).

CONCLUSIONS

Arterial hypertension tended to be more frequently treated among women and different therapeutic options were found according to gender. Gender differences in the awareness of hypertension, sexual specificity of the activity of antihypertensive drugs, and comorbidity may play a role in gender inequalities in the treatment of hypertension in Portugal.