The Particularities of Arterial Hypertension in Female Sex. From Pathophysiology to Therapeutic Management

Arterial hypertension is the most important modifiable cardiovascular risk factor and a major cause of cardiovascular mortality worldwide. In daily clinical practice, the hypertensive patient is often treated in a uniform way, thus ignoring the significant effects of sex on several aspects of hypertension including its prevalence, pathophysiology, response to antihypertensive treatment, and outcomes. The substantial hormonal changes during a woman's life cycle along with the immune response and several cardiometabolic risk factors that frequently coexist are among the main pathophysiological mechanisms driving hypertension in women. Concurrently, women exhibit increased cardiovascular risk at lower blood pressure (BP) levels compared to age-matched men and present certain disparities in the incidence of cardiovascular events and subsequent hypertension-related cardiovascular prognosis. In addition, women respond differently to antihypertensive treatment, experiencing more drug-related side effects, and exhibit lower rates of BP control compared to men. Currently, international guidelines propose the same targets and the same therapeutic algorithms for the treatment of hypertension in both sexes, without taking into account the sex differences that exist. In this review we aim to describe the certain particularities of arterial hypertension in female sex, moving from pathophysiological aspects to clinical and therapeutical management.