Premenopausal Women Have Increased Risk of Hypertensive Target Organ Damage Compared with Men of Similar Age

Background: The impact of high blood pressure (BP) on target organs (TO) in premenopausal women is not well known. The purpose of this study was to describe gender differences in TO involvement in a cohort of young-to-middle-aged subjects screened for stage 1 hypertension and followed for 8.2 years. Methods: Participants were 175 women and 451 men with similar age (range 18-45 years). Ambulatory BP at entry was 127.5+/-12.5/83.7+/-7.2mm Hg in women and 131.9+/-10.3/81.0+/-7.9mm Hg in men. Ambulatory BP, albumin excretion rate (AER), and echocardiographic data (n = 489) were obtained at entry, every 5 years, and before starting antihypertensive treatment. Results: Female gender was an independent predictor of final AER (p = 0.01) and left ventricular mass index (LVMI) (p < 0.001). At follow-up end, both microalbuminuria (13.7% vs. 6.2%, p = 0.002) and left ventricular hypertrophy (LVH) (26.4% vs. 8.8%, p < 0.0001) were more common among women than men. In a multivariable Cox analysis, after adjusting for age, lifestyle factors, body mass, ambulatory BP, heart rate, and parental hypertension, female gender was a significant predictor of time to development of microalbuminuria (p = 0.002), with a hazard ratio (HR) of 3.06, (95% confidence interval [CI] 1.48-6.34) and of LVH (p = 0.004), with an HR of 2.50 (1.33-4.70). Inclusion of systolic and diastolic BP changes over time in the models only marginally affected these associations, with HRs of 3.13 (1.50-6.55) and 3.43 (1.75-6.70), respectively. Conclusions: These data indicate that premenopausal women have an increased risk of hypertensive TO damage (TOD) and raise the question about whether early antihypertensive treatment should be considered in these patients.