Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence
Aune, Arleen; Ohldieck, Annabel Eide; Halvorsen, Lene Vernås; Brobak, Karl Marius; Olsen, Erik; Rognstad, Stine; Larstorp, Anne Cecilie Kjeldsen; Søraas, Camilla Lund; Rossebø, Anne Bjørhovde; Rösner, Assami; Grytaas, Marianne Aardal; Gerdts, Eva
Peer reviewed, Journal article
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Date
2024Metadata
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Original version
High Blood Pressure & Cardiovascular Prevention. 2024, 31, 157-166. 10.1007/s40292-024-00632-6Abstract
Introduction
Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear.
Methods
We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication.
Results
Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30–3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17–3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12–4.00] p = 0.02).
Conclusions
Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence.