(Hypertension. 2000;36:780.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Hypertension and Its Treatment in Postmenopausal Women
Baseline Data from the Women’s Health Initiative
From The Albert Einstein College of Medicine (S.W.-S.), Bronx, NY; the Fred Hutchinson Cancer Research Center (G.A., J.F.), Seattle, Wash; the University of Washington (B.M.P.), Seattle; Rush Presbyterian St. Luke’s Medical Center (H.R.B.), Chicago, Ill; Brigham and Women’s Hospital (J.M.), Harvard Medical School, Boston, Mass; the Heart Disease Prevention Program (N.W.), University of California, Irvine; the University of Minnesota Medical School (R.G.), Minneapolis; the Medical College of Wisconsin (T.K.), Milwaukee; the University of California at San Diego (R.L.), La Jolla; and the University of Medicine and Dentistry of New Jersey (N.L.), Newark.
Correspondence to Sylvia Wassertheil-Smoller, PhD, Department of Epidemiology and Social Medicine, The Albert Einstein College of Medicine, 1300 Morris Park Ave, Room 1312 Belfer, Bronx, NY 10461. E-mail smoller{at}aecom.yu.edu
Abstract—Little is known about
the patterns of treatment and adequacy of blood pressure control in
older women. The Women’s Health Initiative, a 40-center national study
of risk factors and prevention of heart disease, breast and colorectal
cancer, and osteoporosis in postmenopausal women, provides a unique
opportunity to examine these issues in the largest, multiethnic,
best-characterized such cohort. Baseline data from the initial 98 705
women, aged 50 to 79 years, enrolled were analyzed to relate
prevalence, treatment, and control of hypertension to demographic,
clinical, and risk-factor covariates, and logistic regression
analyses were performed to estimate odds ratios after adjusting
for multiple potential confounders. Overall, 37.8% of the women had
hypertension, which is defined as systolic blood pressure
140 mm Hg and/or diastolic blood pressure 90
mm Hg or being on medication for high blood pressure; 64.3% were
treated with drugs, and blood pressure was controlled in only 36.1% of
the hypertensive women, with lower rates of control in the oldest
group. After adjustment for multiple covariates, current hormone users
had higher prevalence than did nonusers (odds ratio 1.25).
Hypertensive women had more comorbid conditions than did
nonhypertensive women, and women with comorbidities were more likely to
be treated pharmacologically. Diuretics were used by 44.3% of
hypertensives either as monotherapy or in combination with other drug
classes. As monotherapy, calcium channel blockers were used in 16%,
angiotensin-converting enzyme inhibitors in
14%, ß-blockers in 9%, and diuretics in 14% of the
hypertensive women. Diuretics as monotherapy were associated
with better blood pressure control than any of the other drug classes
as monotherapy. In conclusion, hypertension in older women is not being
treated aggressively enough because a large proportion, especially
those most at risk for stroke and heart disease by virtue of age, does
not have sufficient blood pressure control.
Key Words: hypertension, essential • age • antihypertensive agents • blood pressure • women • Women’s Health Initiative (WHI)
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