Wilmes Nick, van Luik Eveline M, Vaes Esmée W P, Vesseur Maud A M, Laven Sophie A J S, Mohseni-Alsalhi Zenab, Meijs Daniek A M, Dikovec Cédric J R, de Haas Sander, Spaanderman Marc E A, Ghossein-Doha Chahinda
Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands.
Biomedicines. 2023 May 22;11(5):1494. doi: 10.3390/biomedicines11051494.
In the prevention of cardiovascular morbidity and mortality, early recognition and adequate treatment of hypertension are of leading importance. However, the efficacy of antihypertensives may be depending on sex disparities. Our objective was to evaluate and quantify the sex-diverse effects of beta-blockers (BB) on hypertension and cardiac function. We focussed on comparing hypertensive female versus male individuals.
A systematic search was performed for studies on BBs from inception to May 2020. A total of 66 studies were included that contained baseline and follow up measurements on blood pressure (BP), heart rate (HR), and cardiac function. Data also had to be stratified for sex. Mean differences were calculated using a random-effects model. In females as compared to males, BB treatment decreased systolic BP 11.1 mmHg (95% CI, -14.5; -7.8) vs. 11.1 mmHg (95% CI, -14.0; -8.2), diastolic BP 8.0 mmHg (95% CI, -10.6; -5.3) vs. 8.0 mmHg (95% CI, -10.1; -6.0), and HR 10.8 beats per minute (bpm) (95% CI, -17.4; -4.2) vs. 9.8 bpm (95% CI, -11.1; -8.4)), respectively, in both sexes' absolute and relative changes comparably. Left ventricular ejection fraction increased only in males (3.7% (95% CI, 0.6; 6.9)). Changes in left ventricular mass and cardiac output (CO) were only reported in males and changed -20.6 g (95% CI, -56.3; 15.1) and -0.1 L (95% CI, -0.5; 0.2), respectively.
BBs comparably lowered BP and HR in both sexes. The lack of change in CO in males suggests that the reduction in BP is primarily due to a decrease in vascular resistance. Furthermore, females were underrepresented compared to males. We recommend that future research should include more females and sex-stratified data when researching the treatment effects of antihypertensives.
在预防心血管疾病的发病率和死亡率方面，高血压的早期识别和充分治疗至关重要。然而，抗高血压药物的疗效可能取决于性别差异。我们的目标是评估和量化β受体阻滞剂（BB）对高血压和心脏功能的性别差异影响。我们重点比较了高血压女性和男性个体。
对从开始到2020年5月关于BB的研究进行了系统检索。共纳入66项研究，这些研究包含了血压（BP）、心率（HR）和心脏功能的基线及随访测量数据。数据还必须按性别分层。使用随机效应模型计算平均差异。与男性相比，女性接受BB治疗后收缩压降低11.1 mmHg（95%置信区间，-14.5；-7.8），而男性为11.1 mmHg（95%置信区间，-14.0；-8.2）；舒张压降低8.0 mmHg（95%置信区间，-10.6；-5.3），男性为8.0 mmHg（95%置信区间，-10.1；-6.0）；心率降低每分钟10.8次（bpm）（95%置信区间，-17.4；-4.2），男性为9.8 bpm（95%置信区间，-11.1；-8.4），在两性的绝对和相对变化方面相当。左心室射血分数仅在男性中增加（3.7%（95%置信区间，0.6；6.9））。左心室质量和心输出量（CO）的变化仅在男性中报告，分别变化了-20.6 g（95%置信区间，-56.3；15.1）和-0.1 L（95%置信区间，-0.5；0.2）。
BB在两性中同等程度地降低血压和心率。男性CO无变化表明血压降低主要是由于血管阻力降低。此外，与男性相比，女性的代表性不足。我们建议未来在研究抗高血压药物的治疗效果时，应纳入更多女性和按性别分层的数据。
