Blood pressure (BP) trends differ between men and women across the lifespan. Men typically develop higher systolic BP earlier in life, while women experience a steeper increase after menopause due to declining estrogen. These differences, combined with genetics, contribute to sex-specific risks of hypertension and hypertensive disorders of pregnancy (HDP).
Sex Differences in Blood Pressure
- Before menopause, estrogen helps protect against hypertension by supporting blood vessel relaxation, reducing inflammation, and limiting activation of the renin–angiotensin–aldosterone system (RAAS).
- After menopause, reduced estrogen accelerates BP increases and raises the risk of cardiovascular disease (CVD).
- A 10 mmHg rise in systolic BP increases ischemic heart disease risk by 10% in men but 25% in women.
Hypertensive Disorders of Pregnancy (HDP)
- Affect 5–8% of pregnancies and include chronic hypertension, gestational hypertension, preeclampsia, and eclampsia.
- Linked to higher long-term risks of stroke, heart disease, kidney disease, and heart failure.
- Early or recurrent preeclampsia carries especially strong cardiovascular risks.
Genetics and Heritability
- Both hypertension and HDP are polygenic conditions (influenced by many genes).
- Genome-wide association studies (GWAS) show shared genetic pathways between hypertension and preeclampsia.
- Polygenic risk scores (PRSs) may help predict future risk of HDP or hypertension.
- Family history of preeclampsia doubles the risk of experiencing it in pregnancy.
- Offspring born to preeclamptic pregnancies face higher risks of hypertension, CVD, and stroke later in life.
Chromosomes and Hormone Receptors
- Sex chromosomes (XX vs XY) influence cardiovascular risk, as shown in conditions like Turner syndrome and Klinefelter syndrome.
- Specific genetic variants in estrogen and androgen receptors affect BP differently in men and women.
- Sex-stratified GWAS have identified hundreds of male- and female-specific genetic loci associated with BP regulation.
Takeaway
Hypertension and hypertensive disorders of pregnancy are partly genetic, with important differences between men and women. Understanding these genetic and hormonal pathways could enable sex-specific risk prediction and personalized treatment strategies in the future.