Background:
We investigated gender-specific differences in treatment of hypertension (HTN), and how they may affect outcomes in congestive heart failure (CHF) patients.
Methods:
Records of 194 (100 male, 94 female) unselected consecutive patients with HTN enrolled in the CHF clinic were reviewed. Left ventricular ejection fraction (LVEF) was compared to LVEF at time of enrollment in the clinic. The average interval between the two echocardiograms was 30 months.
Results:
ANOVA, chi-square, and logistic regression analyses demonstrated that men were more likely than women to have baseline LVEF ≤35%, (50% vs. 36%, p=0.108), coronary artery disease (63% vs. 43%, p=0.004), diabetes mellitus (p=0.095), and be ever smokers (66% vs. 40%, p<0.0001). Factors such as age, peripheral vascular disease, hyperlipidemia, serum K+, creatinine clearance, body mass index, and heart rate were similar in both genders.
Optimal BP control noted during the most recent visit was more often achieved in men (59% vs. 46%, p=0.002). Remarkably, during follow up, more men experienced decline in LV dysfunction (29% vs. 18%, p=0.081), women were more likely to have no change in LVEF (51% vs 34%, p=0.081), and men were only slightly more likely to show improvement (37% vs. 31%, p=0.081).
There was no gender difference in utilization of angiotensin converting enzyme inhibitors (ACE), beta blockers (BB), or aldosterone receptor antagonists (ARA). Women were more likely to be treated with angiotensin receptor blockers (ARBs, p=0.054) and men were more likely to be on diuretics (57% vs. 43%, p=0.069).
Conclusions:
In patients with HTN enrolled in the HF clinic, male gender was associated with increased cardiovascular comorbidities and lower LVEF at baseline. Despite improved blood pressure control and similar utilization of evidence-based therapy, men experienced more decline in LVEF, had LV systolic function that was less likely to remain unchanged, and were only slightly more likely to demonstrate improvement of LVEF compared to women. This study suggests a potential gender-related pharmacodynamic difference in response to guideline therapy, or perhaps the manifestation of an already described gender difference of adaptation to chronic elevated after load.
Expert Comment: Is Medication Titration in Heart Failure too Complex?
