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Vascular function in hypertension: does gender dimension matter?

Journal of Human Hypertension volume 37, pages 634–643 (2023)Cite this article

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Abstract

Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while “toxic masculinity” traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women’s vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.

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Fig. 1: Graphical representation of trajectories of vascular ageing, blood pressure, and sex hormones throughout the lifespan in men and women.

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Funding

This paper is based upon work from the European COST ACTION-Network for Research in Vascular Ageing CA18216 supported by COST (European Cooperation in Science and Technology) and endorsed by the German Society of Gender Medicine (DGesGM). AG has received funding from Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I) and from “la Caixa” Foundation (LCF/BQ/PR22/11920008).

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Author notes

  1. These authors contributed equally: Ute Seeland, Pierre Boutouyrie.

Authors and Affiliations

  1. Université Paris Cité, Inserm, PARCC, F-75015, Paris, France

    Rosa-Maria Bruno & Pierre Boutouyrie

  2. Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France

    Rosa-Maria Bruno & Pierre Boutouyrie

  3. Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest, Hungary

    Szabolcs Varbiro

  4. Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary

    Szabolcs Varbiro

  5. Internal Medicine Unit, “Santa Maria” Terni Hospital and Department of Medicine and Surgery—University of Perugia, Perugia, Italy

    Giacomo Pucci

  6. Department of Family Medicine and Health Service of Zuglo (ZESZ), Semmelweis University, Budapest, Hungary

    János Nemcsik

  7. Department of Clinical Science, University of Bergen, Bergen, Norway

    Mai Tone Lønnebakken

  8. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Mai Tone Lønnebakken

  9. Institution for Clinical Science, Intervention and Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden

    Karolina Kublickiene

  10. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

    Helena Schluchter

  11. MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK

    Chloe Park

  12. Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

    Ioana Mozos

  13. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain

    Andrea Guala

  14. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain

    Andrea Guala

  15. AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria

    Bernhard Hametner

  16. Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Ute Seeland

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Consortia

the Sex and Gender VascAgeNet Expert Group

  • Rosa-Maria Bruno
  • , Szabolcs Varbiro
  • , Giacomo Pucci
  • , János Nemcsik
  • , Mai Tone Lønnebakken
  • , Karolina Kublickiene
  • , Helena Schluchter
  • , Chloe Park
  • , Ioana Mozos
  •  & Ute Seeland

Contributions

R-MB conceived the manuscript, provided critical feedback and drafted the manuscript. SV, GP, JN, MTL, KK, HS, CP and IM reviewed the literature and drafted the manuscript. US, PB, BH and AG revised the manuscript and provided critical feedback.

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Correspondence to Rosa-Maria Bruno.

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Bruno, RM., Varbiro, S., Pucci, G. et al. Vascular function in hypertension: does gender dimension matter?. J Hum Hypertens 37, 634–643 (2023). https://doi.org/10.1038/s41371-023-00826-w

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