Sex Differences in Hypertension: Recent Advances.
Sex Differences in Hypertension: Recent Advances.
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DOI：
10.1161/hypertensionaha.116.06602
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Sullivan JC
中科院分区：
文献类型：
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作者：
Gillis EE;Sullivan JC
Gillis和Sullivan高血压的性别差异1323例男性和女性的最佳血压管理，女性仅占36%（强化治疗组中有77名女性对166名男性;标准治疗组89名女性对230名男性），入选女性的心血管事件数量低于一般人群，这项研究被提前终止，因为在男性中更积极的血压控制有明显的好处。5，6因此，女性的结果差异均未达到统计学显著性，并且无法得出关于女性强化BP控制的有效性的结论。如果血压升高与高血压对终末器官损害的影响之间的关系存在性别差异，则更积极的血压控制改善心血管结局的可能性将变得更加重要。Boggia等人7评估了男性（n= 4960）和女性（n = 4397）中与常规和动态血压测量和心血管并发症相关的绝对和相对风险。在两种性别中，24小时动态和常规日间和夜间收缩压是心血管事件的重要预测因子。然而，与男性相比，女性发生与24小时动态收缩压和夜间收缩压相关的心血管事件的风险显著更高。因此，随着血压的升高，女性心血管事件的风险比男性增加得更快，并且潜在可预防事件的比例更高。这些研究结果表明，女性将有更大的心血管好处，从血压下降，并意味着最佳血压是女性比男性低。一项对3344名受试者（1626名女性）进行的前瞻性研究进一步支持了这一观点，该研究发现，女性的动态血压升高与心血管疾病风险之间的关系比男性更陡峭。8后一项研究得出的结论是，男性最佳的基于结果的血压阈值是白天135/85 mm Hg，夜间120/70 mm Hg，而女性白天125/80 mm Hg，夜间110/65 mm Hg。相比之下，一项对5018人（2843名女性）进行的单独荟萃分析检查了男性和女性的传统家庭血压测量与10年心血管风险之间的关系，并没有发现性别之间的显着差异。9这种差异可能是由于测量血压的方法不同（频繁的动态血压测量与孤立的传统血压测量相比）或记录血压的时间不同。无论如何，这些数据提供了足够的证据来质疑目前建议男性和女性血压控制水平相同的指南，并强调了继续研究的重要性。本综述的其余部分集中在免疫系统，特别是T细胞在介导高血压性别差异中的潜在作用。
Gillis and Sullivan Sex Differences in Hypertension 1323 optimal BP management in both men and women, female enrollment was only≈ 36%(77 women in the intensive treatment group versus 166 men; 89 women in the standard treatment group versus 230 men), the number of cardiovascular events in enrolled women was below that seen in the general population, and the study was terminated early because of the clear benefits of more aggressive BP control among men. 5, 6 As a result, none of the outcome differences in women reached statistical significance, and no conclusions could be drawn on the effectiveness of intensive BP control in women. The potential for more aggressive BP control to improve cardiovascular outcomes becomes of even greater interest if there are gender differences in the relationship between elevations in BP with the impact of hypertension on end-organ damage. Boggia et al7 assessed the absolute and relative risks associated with conventional and ambulatory BP measurements and cardiovascular complications in men (n= 4960) and women (n= 4397). In both genders, 24-hour ambulatory and conventional daytime and nighttime systolic BPs were significant predictors of cardiovascular events. However, women had a significantly higher risk of a cardiovascular event in relation to 24-hour ambulatory systolic BP and nighttime systolic BP compared with men. As a result, women exhibited a steeper increase in risk of a cardiovascular event with increases in BP than men and had a higher proportion of potentially preventable events. These findings suggest that women would have greater cardiovascular benefits from decreases in BP and imply that optimal BP is lower in women than in men. This is further supported by a prospective study of 3344 subjects (1626 women), which found a steeper relationship between higher ambulatory BP and cardiovascular disease risk in women than in men. 8 This latter study concluded that the optimal outcome-based BP threshold for men was 135/85 mm Hg during the day and 120/70 mm Hg during the night, compared with 125/80 mm Hg during the day 110/65 mm Hg during the night for women. In contrast, a separate meta-analysis of 5018 people (2843 women) examining the relationship between conventional home BP measurements and 10-year cardiovascular risks in men and women and did not find significant differences between the genders. 9 This discrepancy may be because of the different methods used to measure BP (frequent ambulatory BP measurements compared with isolated conventional BP measurements) or the time of day BP was recorded. Regardless, the data provide sufficient evidence to call into the question current guidelines recommending the same level of BP control in men and women and underscores the importance of continued research. The remainder of this review is focused on the potential role of the immune system, specifically T cells, in mediating sex differences in hypertension.