How The Risks Of Uncontrolled High Blood Pressure Is Affected By Both Gender And Age


Within the United States alone, almost half of all the adult population has difficulty controlling their blood pressure. According to research, older women and younger men tend to have issues controlling their hypertension, even though some of them are already taking medication to lower their blood pressure.

According to health experts, aside from one’s lifestyle choices, some individuals have a low tolerance for such medications that help manage hypertension.

As described by the Centers for Disease Control and Prevention (CDC), hypertension, otherwise known as high blood pressure, ‘is blood pressure that is higher than normal.’ When this occurs, it also heightens one risk of a number of illnesses such as cardiovascular disease, stroke, kidney disease, and even complications from COVID-19.

Notably, over 92 million adults in the United States suffer from high blood pressure. Yet despite these statistics, there are very few studies that look into the way hypertension affects both men and women in their different ages.

But postdoctoral research fellow at Rutgers Institute for Health, Health Care Policy and Aging Research in New Brunswick, NJ, Aayush Visaria, M.D., M.P.H. led a study that looked into this particular issue. The results were presented at the American Heart Association’s (AHA) Hypertension Scientific Sessions 2021.


The Study Findings

In order to do the study, Dr. Visaria and team looked at data from the National Health and Nutrition Examination Surveysfrom 1999 to 2018.

The data included over 13,200 adults from the age of 20 and older that had been diagnosed with hypertension and were taking medication to lower their blood pressure.

On average, the participants’ age was 57 years, with women making up 52% of the participants, and 71% of the participants were white.

The research group separated all the participants into 10-year age groups, after which they compared the rates of the uncontrolled hypertension between the women and the men.

They also looked at the hypertension control rates by ‘using older and newer definitions of high blood pressure.’ According to the 2014 Joint National Commission (JNC) guidelines, they explain high blood pressure to be 140/90 millimeters of mercury (mm Hg) or higher, while in 2017, the American College of Cardiology (ACC) and AHA had guidelines that defined it as 130/80 mm Hg or higher.

The research group also made sure to adjust their data for comorbidities, as well as social, behavioral, metabolic and demographic factors.


Looking At Uncontrolled Hypertension

From the gathered data, the study authors found that 34% of the 13,253 participants had uncontrolled hypertension. Also, mean and women between the ages of 50 to 69 that had similar chances of having this condition as well. Although, the study also shared the following different observations in the other age groups:

  • For participants between the ages of 20 to 29, men had a 59% greater chance of uncontrolled hypertension than women.
  • For participants between the ages of 30 to 39, men had a 70% increased risk of uncontrolled hypertension compared with women.
  • For participants between the ages of 40 to 49, the men were 47% more likely to end up with uncontrolled hypertension than women.
  • For participants between the ages of 70 to 79, the women had a 29% greater chance of ending up with uncontrolled hypertension than the men.
  • For participants aged 80 and above, the women were 63% more likely to end up with uncontrolled hypertension than the men.

While these results were based on the AHA / ACC guideline definition of hypertension, the JNC definition had similar findings as well.


What Are the Risk Factors For Young Men?

Founding co-director of the Racial Justice Institute, founder and director of the Center for Men’s Health Equity, and professor of health systems administration and oncology at Georgetown University in Washington, D.C., Derek M. Griffith, Ph.D. spoke with Medical News Today (MNT) about the findings.

He said, “It is great to see the American Heart Association begin to look at these issues by gender. We have long known that men under 50 have particularly poor health profiles, despite middle-age being portrayed as the prime of life. From age 35 and up, heart disease is one of the top two leading causes of death for men, and much of heart disease mortality is due to uncontrolled hypertension.”

Dr. Griffith also referred to a 2018 study that suggests men aged 45 to 64 years in age have a higher risk of stroke than women in both white and Black populations. He also things that young and middle-aged men tend to struggle with heart health “because of the multiple role demands and financial pressures that cluster in middle-age.”

He went on to explain further, “The current generation of young adults have tended to delay pursuing key adult roles and responsibilities, [such as] marriage, homeownership, and beginning careers. [They have] faced considerable student loan debt, stagnant wages, increased social isolation, and sedentary behavior associated with technology use – [for example,] social media, video games, [and] binge watching shows and movies. These factors are sources of stress that may raise blood pressure and stimulate unhealthy eating, sugar sweetened beverage consumption, smoking, alcohol us, and other behaviors […]. These stress-coping behaviors can lead to high blood pressure.”

He added that when it comes to middle age, lifestyle choices and experiences up to that point tend to lead to physical decline.

Cardiologist and medical director of noninvasive cardiology at MermorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, Jennifer Wong, M.D. FACC also told MNT in an interview that she had the same findings in her own anecdotal observations. In fact, she also shared a number of factors she believes contributes to higher incidents of uncontrolled hypertension when it comes to young men.

Dr. Wong explains, “I think for younger patients, it could be an element of noncompliance: not going to doctors, not taking medications… […] especially young men.”

She also says that she has observed that hypertension in some of her younger male patients tends to be more resistant to medications. Meanwhile, younger individuals “also tend to be more sensitive to medications.”

Also, Dr. Wong explains that younger patients tend not to tolerate beta-blockers, which is a commonly used blood pressure-lowering medication.


How About Older Women?

As explained by Dr. Visaria and his study co-authors, “[…] women tend to have an accelerated increase in blood pressure and cardiovascular disease risk after menopause.”

Dr. Wong also shares that it’s rather difficult to treat older women dealing with uncontrolled hypertension. From her observations, she shares, “[O]lder women tend not to tolerate lower blood pressures, so [it’s] difficult to treat the high blood pressures without running into lower blood pressure where they feel underperfused.”

But for Dr. Wong, the concern lies more in the way society underestimates the ‘prevalence and severity of cardiovascular disease in women.’

While statistics show that men tend to develop heart disease more than women, this illness “is still the number one killer in women, more than breast cancer.”


Still Needing Further Studies

The researchers do agree that the study has certain limitations. One example is that the study’s health data only provided one blood pressure reading at one time point for every participant. Considering it was a single reading, it was not enough to accurately quantify their blood pressure, which commonly fluctuates all throughout the day.

Dr. Visaria also says that further research is needed to figure out the reasons behind the differences in uncontrolled hypertension.

He proposes, “In order to really determine whether uncontrolled hypertension rates are changing in women vs. men across age, a prospective study where blood pressure measurements are tracked over time in women and men with hypertension is ideal.”