Response to Gender and Blood Pressure Control
We thank Barrios et al1 for their interest in our recent publication. Our work identified gender disparities in blood pressure control and receipt of recommended preventive therapies in ambulatory practices across the Unites States.2 In a sample of 12 064 visits (7786 women and 4278 men), women were less likely than men to meet blood pressure control targets, especially older women aged 65 to 80 years, and to receive recommended therapies, such as aspirin and β-blockers, for the secondary prevention of cardiovascular disease. Barrios et al1 conducted a cross-sectional study in which a survey of 12 954 primary care patients in Spain with hypertension (6468 women and 6486 men) did not reveal any difference in blood pressure control based on gender after multivariate analysis.3
Barrios et al1 conclude that the gender-based difference in blood pressure control seen in our study is not generally applicable to other populations with a different risk profile, such as Spain, where stroke, not ischemic heart disease, as seen in men, is the leading cause of death in women. They suggest that this difference in cardiovascular risk of death may increase awareness among Spanish physicians of the importance of attaining blood pressure control targets in women and, therefore, may partly explain the similar rates of blood pressure control between genders in Spain.
Unfortunately, blood pressure control in Spain is low.3 Blood pressure control in the study by Barrios et al1 was 24.8%, which was markedly lower than the blood pressure control in the United States (54% for women). Similar differences in blood pressure control rates between Western European countries and the United States have also been reported by Wang et al4 and Wolf-Maier et al.5 Therefore, it is unlikely that there is an increased awareness among Spanish physicians of the importance of attaining blood pressure control in women. Blood pressure control is less than satisfactory in women and men throughout the world.
Sources of Funding
This project was not directly supported by any external grants or funds. S.K. is supported by a VA HSR&D Career Development Award. M.A.M. is supported in part by the National Institutes of Health Centers of Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training (Project EXPORT). The views expressed in this letter are those of the authors and do not reflect the views of any funding agency.
Barrios V, Escobar C, Echarri R, Matalí A. Gender and blood pressure control. Hypertension. 2008; 51: e48.
Keyhani S, Scobie JV, Hebert PL, McLaughlin MA. Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension. 2008; 51: 1–7.
Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, Poulter N, Primatesta P, Stegmayr B, Thamm M. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004; 43: 10–17.