Gender-Specific Hypertension Guidelines Are Needed to Improve Stroke Prevention

Compared with men, women have a higher increased risk for ischemic stroke as the severity of their hypertension increases, according to findings from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

To conduct the longitudinal cohort study, the researchers recruited 26,461 black and white participants who did not have prevalent stroke at baseline from 2003 to 2007. There was an oversampling of participants who were black (40.2%) and who lived in the Stroke Belt. Women comprised 55.4% of the participants.


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The participants reported any incident of ischemic stroke via telephone surveillance; physicians then determined the validity of the suspected events. In all, 1084 ischemic stroke events were confirmed.

After adjusting for age, race, gender, and age-by-race and gender-by-treatment interaction terms, the researchers assessed the gender-specific association between systolic blood pressure and stroke, and between classes of antihypertensive medications and stroke.

The hypertension levels were categorized as a systolic blood pressure of:

  • Less than 120 mm Hg
  • 120 mm Hg to 129 mm Hg
  • 130 mm Hg to 139 mm Hg
  • Greater than 140 mm Hg

The risk of stroke per each level of hypertension was greater among women than men.

“Compared with no medications, with each additional class of medications, stroke risk increased by 23% (hazard ratio, 1.23; 95% CI, 1.14–1.33) for women and 21% (hazard ratio, 1.21; 95% CI, 1.12–1.31) for men (P = 0.79),” the researchers wrote.

According to the researchers, the trends in their findings suggest that differences between men and women in terms of hypertension and stroke risk are larger among white individuals compared with black individuals.

“Further work on the biological mechanisms for sex differences in stroke risk associated with hypertension severity and a need for sex-specific clinical guidelines may be warranted,” the researchers concluded.

—Colleen Murphy


Madsen TE, Howard G, Kleindorfer DO, et al. Sex differences in hypertension and stroke risk in the REGARDS Study: a longitudinal cohort study. Hypertension. 2019;74(4):749-755. doi:10.1161/HYPERTENSIONAHA.119.12729.