Vascular function in hypertension: does gender dimension matter?

Helena Schluchter, Chloe Park, Rosa-Maria Bruno, Szabolcs Varbiro, Giacomo Pucci, János Nemcsik, Mai Tone Lønnebakken, Karolina Kublickiene, Ioana Mozos, Andrea Guala, Bernhard Hametner, Ute Seeland, Pierre Boutouyrie

Journal: Journal of human hypertension 2023;37(8):634-643

PMID: 37061653

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Abstract

Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while "toxic masculinity" traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women's vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.

Address: Université Paris Cité, Inserm, PARCC, F-75015, Paris, France. [email protected].; Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France. [email protected].; Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest, Hungary.; Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.; Internal Medicine Unit, "Santa Maria" Terni Hospital and Department of Medicine and Surgery-University of Perugia, Perugia, Italy.; Department of Family Medicine and Health Service of Zuglo (ZESZ), Semmelweis University, Budapest, Hungary.; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.; Institution for Clinical Science, Intervention and Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.; MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK.; Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.; AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria.; Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.; Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.; Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France.

DOI: 10.1038/s41371-023-00826-w

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MeSH Terms: Male, Humans, Female, Women's Health, Hypertension, Smoking, Aging, Sexual Behavior, Sex Factors