BP Reduction Therapy Similar in Men and Women for CVD Prevention

Blood pressure-lowering pharmacotherapy decreases risk for major cardiovascular disease (CVD) events similarly in men and women in all BP and age categories, according to a study in Hypertension.

Researchers conducted a participant-level data meta-analysis to evaluate the effects of BP-lowering treatment on the risk for major CVD events with use of the Blood Pressure Lowering Treatment Trialists’ Collaborations (BPLTTC) data set.

The analysis included all trials with a minimum of 1000 person-years of follow-up in randomly assigned groups and trials that reported data on sex, age, and BP levels during randomization and follow-up. The primary outcome was the first major CVD event.

Analysis also was conducted according to baseline categories of systolic BP in 10-mm Hg increments from 120 to 170 mm Hg and the age categories of younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years or older, as well as the interaction between treatment and sex in each category.

A total of 51 randomized controlled trials with 358,635 participants were included, and 41.6% of the participants (n=149,193) were women. The women had a mean (SD) age of 66.2 (9.8) years vs 64.2 (9.4) for the men.

The median follow-up was 4.2 years, and 43,350 major CVD events occurred. The incidence rate for the primary outcome was 8.7 (95% CI, 8.5-8.8) per 100,000 person-years in women and 11.1 (95% CI, 11.0-11.2) per 100,000 person-years in men.

The incidence rates of major CVD outcomes in the treatment and comparator groups among women were 7.8 (95% CI, 7.6-8.0) and 9.5 (95% CI, 9.3-9.7) per 100,000 person-years, respectively, compared with corresponding incidence rates in men of 10.4 (95% CI, 10.2-10.6) and 11.8 (95% CI, 11.6-11.9) per 100,000 person-years, respectively.

Hazard ratios associated with a 5-mm Hg decrease in systolic BP for risk for the primary outcome were 0.92 (95% CI, 0.89-0.95) in women vs 0.90 (0.88-0.93) in men, with no statistically significant heterogeneity of relative effect between sexes observed (all P for interaction, ≥0.38).

No heterogeneity of relative treatment effects was observed by sex for major CVD events in any age category (all P for interaction, ≥.54). In addition, no evidence was found that the relative effects were different between women and men by systolic BP at baseline (all P for interaction, ≥.57).

An analysis that included a stratified network meta-analysis showed no evidence of a difference in treatment effects between women and men for any of the drug classes.

Among several limitations, all eligible trials were not included in the meta-analysis, and some conditions, such as peripheral vascular diseases, were different between men and women for diagnosis and treatment. Also, the outcomes are defined based on a series of major CVD events and do not include other important vascular conditions, and information on menopause status was not available.

“This extensive study affirms the efficacy of BP-lowering interventions in reducing CVD risk across both sexes,” wrote the investigators. “It advocates for an approach to BP management that prioritizes individual cardiovascular risk profiles, challenging the reliance on a single determinant like age or sex.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.