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Blood pressure load per body surface area is higher in women than in men

Journal of Human Hypertension volume 35, pages 371–377 (2021)Cite this article

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Abstract

Many unexplained sex differences have been observed in blood pressure (BP) related morbidity. However, there has been little research about the most obvious difference between men and women—body size. Given that blood vessels are organs of tubular shape, we hypothesized that correction of BP for body surface area (BSA), a two-dimensional measurement of body size, would allow comparison of BP load between men and women. We assessed the relationship of 24-h ambulatory BP measurements and BSA in 534 participants (mean age 61 ± 3 years, 51% women) from the Helsinki Birth Cohort Study. The study subjects had no previous medication affecting vasculature or BP. When BP values were adjusted for age, smoking, physical activity, and body fat percentage, males had higher ambulatory daytime mean systolic BP (131 mmHg vs. 127 mmHg, p < 0.001), diastolic BP (83 mmHg vs. 78 mmHg, p < 0.001), and mean arterial pressure (100 mmHg vs. 96 mmHg, p < 0.001) than females. However, all BP components per unit of BSA were significantly lower in males: daytime mean systolic BP (65 mmHg vs. 71 mmHg, p < 0.001), diastolic BP (41 mmHg vs. 44 mmHg, p < 0.001), pulse pressure (24 mmHg vs. 28 mmHg, p = 0.013), and mean arterial pressure (49 mmHg vs. 54 mmHg, p < 0.001). The same phenomenon was observed in night-time BP values. BP load per BSA is higher in women than in men, which may explain many reported sex differences in cardiovascular morbidity. Relatively small-sized individuals might benefit from a more aggressive therapeutic strategy.

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Fig. 1: Distribution of body surface area according to sex.
Fig. 2: The means of body mass index and body surface area in men and women.
Fig. 3: Mean ratio between men and women in different daytime and night-time ambulatory blood pressure components.
Fig. 4: Magnitude of the effect of body surface area as a continuous variable on the ambulatory blood pressure components.

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Funding

The Helsinki Birth Cohort Study has been supported by grants from Finska Läkaresällskapet, the Finnish Special Governmental Substudy for Health Sciences, Academy of Finland, Samfundet Folkhälsan, Liv och Hälsa, and Signe and Ane Gyllenbergs Foundation. The funding sources did not participate in the design of the study, the analysis or the interpretation of the data, the writing of this paper, or the process to submit this article for publication. The independence of the researchers from funders is declared.

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Authors and Affiliations

  1. Department of General Practice, Turku University and Turku University Hospital, Turku, Finland

    Päivi E. Korhonen & Samuel Palmu

  2. Central Satakunta Health Federation of Municipalities, Harjavalta, Finland

    Samuel Palmu

  3. Folkhälsan Research Center, Helsinki, Finland

    Hannu Kautiainen & Johan G. Eriksson

  4. Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland

    Hannu Kautiainen

  5. Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Johan G. Eriksson

  6. Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore

    Johan G. Eriksson

  7. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Johan G. Eriksson

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  1. Päivi E. Korhonen
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Correspondence to Päivi E. Korhonen.

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The Ethics Committee for Epidemiology of Helsinki and Uusimaa Hospital District approved the study.

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Korhonen, P.E., Palmu, S., Kautiainen, H. et al. Blood pressure load per body surface area is higher in women than in men. J Hum Hypertens 35, 371–377 (2021). https://doi.org/10.1038/s41371-020-0339-z

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