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Sex, gender, and subclinical hypertensiveorgan damage—heart

Journal of Human Hypertension volume 37, pages 626–633 (2023)Cite this article

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Abstract

Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. Although the risk of cardiac HMOD is related with the severity of BP elevation, the interaction of numerous non-hemodynamic factors plays a relevant role in this unfavorable dynamic process. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described. The objective of the present review is to provide comprehensive, updated information on sex-related differences in cardiac HMOD, focusing on the most important manifestations of subclinical hypertensive heart disease such as left ventricular hypertrophy (LVH), LV systolic and diastolic dysfunction, left atrial and aortic dilatation. Current evidence, based on cross-sectional and longitudinal observational studies as well as real-world registries and randomized controlled trials, suggests that women are more at risk of developing (and maintaining) LVH, concentric remodeling and subclinical LV dysfunction, namely the morpho-functional features of heart failure with preserved ejection fraction. It should be pointed out, however, that further studies are needed to fill the gap in defining gender-based optimal therapeutic strategies in order to protect women’s hearts.

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Fig. 1: Echocardiographic phenotyping of subclinical hypertensive-mediated organ damage.
Fig. 2
Fig. 3: Prevalence rates of left ventricular diastolic dysfunction in elderly hypertensives (data in the whole sample as well as in men and women).
Fig. 4: Global longitudinal strain (GLS) and global circumferential strain (GCS) in male and female hypertensive patients.
Fig. 5: Prevalence rates of left atrial dilatation, as assessed by echocardiography, in male and female hypertensive patients.

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy

    Cesare Cuspidi

  2. Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy

    Elisa Gherbesi & Carla Sala

  3. Department of Cardiology, University Hospital “Dr. Dragisa Misovic—Dedinje”, Belgrade, Serbia

    Marijana Tadic

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CC planned the general design of the review and wrote the first draft; EG and CS carried out the research and analysis of the relevant literature, and prepared the figures. MT contributed to the final draft preparation of the paper. All authors made their critical contributions to the final paper and its subsequent revision.

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Cuspidi, C., Gherbesi, E., Sala, C. et al. Sex, gender, and subclinical hypertensiveorgan damage—heart. J Hum Hypertens 37, 626–633 (2023). https://doi.org/10.1038/s41371-022-00750-5

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