Hanus Katarzyna M, Prejbisz Aleksander, Gąsowski Jerzy, Klocek Marek, Topór-Mądry Roman, Leśniak Wiktoria, Kabat Marek, Czarnecka Danuta, Kawecka-Jaszcz Kalina, Narkiewicz Krzysztof, Januszewicz Andrzej
Kardiol Pol. 2017;75(5):421-431. doi: 10.5603/KP.a2017.0020. Epub 2017 Feb 2.
Recent meta-analyses indicate that the pooled prevalence of resistant hypertension (RHT) barely differs between the sexes. However, differences between women and men with RHT in patient characteristics, associated factors, and hypertension (HT) management are still not well-described.
In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males, ≥ 18 years old, and treated for at least 12 months with antihypertensive drugs. We defined HT control as blood pressure (BP) levels both < 140 mm Hg/< 90 mm Hg. Patients were divided into three groups: controlled HT, uncontrolled HT (not fulfilling the criteria of RHT), and RHT (uncontrolled HT despite using three antihypertensive drugs including diuretic). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines.
There were no differences in the rates of controlled HT (47.6% vs. 47.0%), uncontrolled HT (27.3% vs. 28.8%), and RHT (25.1% vs. 24.2%) between women and men, respectively (p = 0.17). Among patients with RHT, women were older than men and had lower diastolic BP and estimated glomerular filtration rate (eGFR) as well as higher pulse pressure (PP). Cerebro-vascular diseases (16.9% vs. 14.3%; p = 0.062), abdominal obesity, and metabolic syndrome (MS, 70.5% vs. 60.1%; p < 0.001) were more frequent among women than men with RHT. Women with RHT had higher rate of high/very high added CV risk in comparison to men. In a multivariate model higher PP, presence of MS, CV disease, and eGFR < 60 mL/min/1.73 m² were related to the presence of RHT both in males and females. In women RHT was also related to abdominal obesity, cerebro-vascular diseases, and diseases causing disability. In men, RHT was additionally related to diseases requiring treatment with non-steroidal anti-inflammatory drugs.
Although there were no differences in the rate of RHT between women and men, we identified gender-related differences in CV risk profiles in RHT patients and in factors related with the presence of RHT. When divided into age groups, RHT was less frequent in women aged less than 40 years and aged between 40 and 65 years, and among patients 65 years and older there was a tendency towards a higher rate of HT in women.
近期的荟萃分析表明，难治性高血压（RHT）的合并患病率在性别之间几乎没有差异。然而，患有RHT的女性和男性在患者特征、相关因素以及高血压（HT）管理方面的差异仍未得到充分描述。
在这项基于横断面问卷调查的观察性研究中，我们纳入了7306名年龄≥18岁、接受至少12个月抗高血压药物治疗的高血压女性和5069名高血压男性。我们将HT控制定义为血压（BP）水平均<140 mmHg/<90 mmHg。患者被分为三组：血压控制良好的HT、未控制的HT（不符合RHT标准）和RHT（尽管使用了包括利尿剂在内的三种抗高血压药物但血压仍未得到控制）。根据2013年欧洲高血压学会/欧洲心脏病学会（ESH/ESC）指南评估心血管（CV）风险。
女性和男性在血压控制良好的HT（47.6%对47.0%）、未控制的HT（27.3%对28.8%）和RHT（25.1%对24.2%）的发生率上分别没有差异（p = 0.17）。在患有RHT的患者中，女性比男性年龄更大，舒张压和估计肾小球滤过率（eGFR）更低，脉压（PP）更高。患有RHT的女性比男性更频繁地出现脑血管疾病（16.9%对14.3%；p = 0.062）、腹型肥胖和代谢综合征（MS，70.5%对60.1%；p < 0.001）。与男性相比，患有RHT的女性具有更高的高/非常高的额外CV风险发生率。在多变量模型中，更高的PP、MS的存在、CV疾病以及eGFR < 60 mL/min/1.73 m²与男性和女性中RHT的存在均相关。在女性中，RHT还与腹型肥胖、脑血管疾病以及导致残疾的疾病相关。在男性中，RHT还与需要使用非甾体抗炎药治疗的疾病相关。
尽管女性和男性在RHT发生率上没有差异，但我们在RHT患者的CV风险特征以及与RHT存在相关的因素中发现了性别相关差异。按年龄组划分时，RHT在年龄小于40岁以及年龄在40至65岁的女性中发生率较低，在65岁及以上的患者中，女性有HT发生率更高的趋势。
