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Published Online, 18 November 2008, www.theannals.com, DOI 10.1345/aph.1L036.
 The Annals of Pharmacotherapy: Vol. 42, No. 12, pp. 1772-1781. DOI 10.1345/aph.1L036
© 2008 Harvey Whitney Books Company.
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HYPERTENSION

Sex Differences in Blood Pressure Response to Antihypertensive Therapy in Chinese Patients with Hypertension

XiaoHan Fan, MD PhD

Cardiologist, Department of Cardiology, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Yunfeng Han, PhD

at time of study, PhD Candidate, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; now, Cardiologist, Department of Geriatrics, General Hospital of Beijing Military, Beijing, China

Kai Sun, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Yibo Wang, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Ying Xin

PhD Candidate, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Yongyi Bai

PhD Candidate, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Weiju Li, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Tao Yang, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Xiaodong Song, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Hu Wang, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Chunyan Fu, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Jingzhou Chen, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Yi Shi, PhD

Research Fellow, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

XianLiang Zhou, MD

Clinical Professor, Department of Cardiology, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Haiying Wu, MD

Clinical Professor, Department of Cardiology, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Rutai Hui, MD PhD

Professor and Medical Director, Division of Hypertension, Department of Cardiology; Professor and Director, Sino-German Laboratory for Molecular Medicine & Key Laboratory for Clinical Cardiovascular Genetics, Ministry of Education, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Reprints: Dr. Hui, Cardiovascular Institute & FuWai Hospital, Chinese Academy of Medical Sciences, 167 Beilishilu, Beijing 100037, China, fax +86 (10) 6833 1730, huirutai{at}sglab.org

BACKGROUND: Sex-specific responses to antihypertensive drugs are not very well understood.

OBJECTIVE: To investigate sex-related differences in blood pressure response to antihypertensive drugs in a community-based prospective clinical trial.

METHODS: We recruited 3535 untreated hypertensive patients (2326 women), aged 40-75 years, from 7 rural communities in China. Subjects were randomized to 1 of 4 drug groups: atenolol, hydrochlorothiazide (HCTZ), captopril, or sustained-released nifedipine; duration of the study was 8 weeks. Mean blood pressure reduction, blood pressure control rates, and frequency of adverse events were compared between men and women.

RESULTS: Women had a better response to HCTZ in relation to diastolic blood pressure (1.8 mm Hg lower) than did men (p < 0.05) and were 57% more likely to reach the control goal of diastolic blood pressure than were men (p < 0.05). In the atenolol group, mean systolic blood pressure decreased 3.9 mm Hg more in women than in men (p < 0.05), and women were 65% more likely to reach the control goal of systolic blood pressure and 57% more likely to reach the control goal of diastolic blood pressure than were men (p < 0.05). Significant sex-related differences were also found in drug-related adverse events in the nifedipine group (15.8% in women vs 9.8% in men; p = 0.017) and in the captopril group (14.3% in women vs 8.4% in men; p = 0.005), but no differences were seen with HCTZ or atenolol.

CONCLUSIONS: Women have better blood pressure responses to HCTZ and atenolol and experience more adverse effects with sustained-release nifedipine and captopril than do men, indicating that sex should be taken into account when selecting antihypertensive drugs.

Key Words: antihypertensive drugs, hypertension, men, women

Published Online, November 18, 2008. www.theannals.com, DOI 10.1345/aph.1L036




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