Sex BP – Sex Differences in Blood Pressure

Dr. Ann G Henry MD
Dr. Ann G Henry is a general physician with brilliant academic background. She is well known for hour counseling and quick diagnosis skills. She is researching blood clot-related complications in young women. Dr. Ann G Henry is working with the Learnfromdoctor as a general physician from 2021.

Sex BP – Blood Pressure Difference in Sex

Sex differences in blood pressure(Sex BP) trajectories, which begin early and persist with aging, may lay the groundwork for later-life heart disease, which frequently manifests differently in men and women.

Importance of Sex Bp

If we make the assumption that men and women have variations of the same fundamental vascular physiology, regular analyses of subclinical measures would recommend that by midlife, women have caught up to men in the extent of potentially significant vascular disease.

Alternatively, assuming that vascular physiology differs fundamentally between men and women, a sex-specific analysis of existing data could provide new insights and deepen our understanding of sex(gender) differences in heart disease.

The goal of this article is to see if longitudinal patterns of blood pressure (BP) slope differ between men and women throughout their lives, using baseline BP levels as a guide.


Overview of Sex BP

Over the last two decades, mounting evidence has revealed differences in the manifestation of common cardiovascular diseases between men and women (CVDs). Women, it is widely assumed, are affected by the same types of CVD as men, albeit with delayed onset and frequently atypical symptoms. However, in the case of ischemic heart disease (IHD) and heart failure (HF), it is now widely acknowledged that women are more likely than men to develop coronary microvascular dysfunction (CMD) and HF with preserved ejection fraction (HFpEF), particularly when vascular risk factors such as hypertension are present. In effect, the growing clinical experience of managing CVD conditions that manifest differently in men and women, combined with data on sex-specific CVD presentations, suggests that cardiovascular pathophysiology is likely to be fundamentally different between the sexes. If this is true, then intrinsic sexual dimorphism in cardiovascular pathophysiology must follow from sexual dimorphism in cardiovascular physiology. We need to use comprehensive sex-specific analysis of blood pressure (BP) trajectories over the life course to better understand how sex differences in earlier-life cardiovascular physiology may precede sex differences in later-life cardiovascular pathophysiology.

Measurement of BP Sex

Systolic and diastolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in seated users who had been resting for at least 5 minutes using a mercury column sphygmomanometer in FHS, a Hawksley random zero sphygmomanometer in ARIC and CARDIA, and Omron model HEM907XL oscillometric BP monitor in CARDIA, and an automated oscillometric To account for between-method heterogeneity, we have to use the mercury sphygmomanometer(column type) – (FHS) as a reference and adjust BP measurements in ARIC by SBP plus 2.6 mm Hg and DBP plus 6.2 mm Hg, as well as adjusted BP measurements in MESA by SBP plus 0.5 mm Hg and DBP plus 2.9 mm Hg, using  a specific correction method. For CARDIA, we calibrated oscillometric values to Hawksley random zero sphygmomanometer measurements (step 1), and then adjusted BP measurements to mercury sphygmomanometer(column) by SBP plus 2.4-2.7 mm Hg and DBP plus 6.2 mm Hg (step 2). To compensate for the therapeutic response of antihypertensive therapy on blood pressure, we have to impute untreated values by adding 10 mm Hg to SBP and 5 mm Hg to DBP values observed in the setting of antihypertensive therapy, and mean arterial pressure (MAP) and pulse pressure (PP) was calculated using these imputed values: PP = SBP DBP and MAP = DBP + (1/3) PP.

In addition, we must perform a sensitivity analysis using alternative imputation methods, such as

  • Increasing SBP by 15 mm Hg and DBP by 10 mm Hg
  • SBP is increased by 15 mm Hg, and DBP is increased by 5 mm Hg.

Mixed-effects regression models were used to show blood pressure trajectories in men and women separately, with age serving as the common timescale for all analyses. To allow for nonlinear relationships, we need to use repeated BP measures to fit mixed-effects linear regression models with each BP measure as the results, participant identifications as random intercepts, and age as a response variable expressed using restricted cubic splines with 4 knots. The mean level of each BP measure was approximated for women and men individually over an age range of 18 (0.5th percentile) to 85 (99.5th percentile). We after which calculate BP change from the guideline BP level, as well as the divergences in BP increment between men and women, based on the premise of sex-specific physiology. The likelihood ratio test was used to compare models with and without parameters trying to represent the interaction between sex and the cubic spline variables representing age to see if there were differences between sexes in the correlations between BP measures and age. Explanatory variables such as body mass index (calculated as weight in kilograms divided by height in meters squared), total cholesterol, diabetes mellitus, and current smoking status were further adjusted in mixed-effects regression models. In secondary analyses, we repeated all models stratified by race/ethnicity (white vs black people), cohort, and antihypertensive medication use (with vs without antihypertensive therapy).

We need to look at sex-specific CVD incidence in our multicohort sample to understand sex-specific BP trajectories in context. We define incident hard CVD as a new-onset fatal or nonfatal myocardial infarction, heart failure, or stroke, as determined by established criteria that are known to be broadly similar across all cohorts. We must calculate the Kaplan-Meier cumulative incidence of hard CVD by gender.

Read Cardiac Index – Cardiac Output

Discussion on BP Difference on Sex(Sex BP)

If we make the assumption that men and women have variations of the same fundamental physiology, then conventional analyses of longitudinal BP data will indeed suggest that by midlife, women have caught up to men in the extent of vascular disease manifesting as age-related elevations in BP. Therefore, if we decertify this hypothesis and take into account the possibility that physiology, including vascular physiology, differs fundamentally between men and women, then sex-specific data analyses can reveal new insights. When we allow sex-stratified analyses of longitudinal data with serial BP measures compared to baseline levels, women clearly outperform men in terms of a steeper increase in BP that begins as early as the third decade and continues throughout life.


Despite numerous previous reports of age-related BP trends in men and women, relatively little work has been done to investigate life course BP trajectories in relation to sex-specific baseline values. Scientists and doctors observed a steeper rise in SBP with aging in women compared to men in a study of over 30 000 predominantly white adults enrolled in 8 UK locations. Our study builds on previous research by thoroughly examining all BP measures, including PP and MAP, in a multiracial sample drawn from several large US cohorts. Despite the fact that our discussion did not include any children or young adults. A study conducted in the United Kingdom examined serial BP data from the Bogalusa Heart Study and discovered no sex differences from ages 5 to 14 years, but then elevated slopes of SBP and DBP rise in male individuals than female individuals started at age 15 years (coinciding with peripubertal growth), followed by steeper slopes of SBP and DBP rise in women than men beginning in the 20s to 30s. These findings are also consistent with ours, indicating that the sex differences in BP trajectories observed throughout adulthood begin early in life.

When we adjusted our assessments for cardiometabolic risk factors, we discovered that the rates of increase for all BP measures were correspondingly attenuated in both sexes, as predicted and consistent with the idea that risk factor exposures contribute significantly to the progressive age-related rise in BP. Noticeably, in these adjusted analyses, women’s BP increase trajectories stayed more pronounced than men’s.

Sexual dimorphism in age-related BP slope may be caused by a variety of influences, including hormonal differences, chromosomal differences, and sex-biased non-chromosomal gene expression. Importantly, complex social, economic, and structural environmental factors cause differences in women’s and men’s lived experiences, which can affect physiology as well as vascular biology. Nonetheless, the most widely accepted contributors to biological sex differences continue to be those associated with sex hormones (ie, type and timing of menarche, pregnancy, and menopause). Even so, the evidence to date suggests that episodes of hormonal variation or perturbation are insufficient to account for the sex differences in cardiovascular phenotypes that are consistently observed over the course of a person’s life.

Women have smaller total body size on average than men, as well as smaller organs, such as the heart, and smaller vessel caliber, such as the coronary arteries, even after adjusting for body surface area. These morphologic differences are most likely accompanied by intrinsic physiologic differences that become more visible and persistent with aging and the age-related accumulation of common risk exposures. This construct is consistent with our finding that MAP (a measure that primarily reflects small artery compliance) rises faster in women than in men over the life span. As a result, the higher rate of MAP increase in women, which may be indicative of small artery remodeling (media-to-lumen ratio), may contribute to women having a higher prevalence of CMD than men. The higher rate of PP increase in women, owing to accelerated arterial stiffening and greater concentric left ventricular remodeling, may contribute to the increased risk of HFpEF in women. Alternatively, or additionally, sex differences in BP associations with systemic microvascular inflammation and oxidative stress may contribute to coronary microvascular endothelial dysfunction and adverse myocardial remodeling, the putative subclinical precursors to CMD and HFpEF.

BP Sex Summery

We analyzed BP patterns over the life course in a gender-specific manner and discovered that progressive BP elevation has gone up more rapidly in women than in men, starting as early as the third decade of life. In contrast to the widely held belief that important vascular diseases in women develop 10 to 20 years later than in men, our findings show that certain vascular changes not only develop sooner but also develop quickly in women than in men. In effect, sex differences in physiology, beginning in childhood, may well set the stage for later-life cardiac and vascular diseases, which frequently manifest differently in women than in men. More research is needed to better understand the role of sexual dimorphism in cardiovascular risk in order to optimize treatment and protection efforts in both men and women.

High Blood Pressure and Sex(Sex BP)

High blood pressure frequently has no warning signs or symptoms. However, the effect on your sex life may be noticeable. Although sexual behavior is unlikely to pose a direct threat to your health, such as a heart attack, high blood pressure can have an impact on your overall gratification with sex.

In men, a connection has been established between high blood pressure and sexual dysfunction. High blood pressure has not yet been proven to be the cause of decreased sexual satisfaction in women.


Challenges of Men’s BP on Sex

High blood pressure tends to cause the coating of the blood vessels to deteriorate over time, causing arteries to harden and thin (atherosclerosis), limiting blood flow. As a result, less blood rushes to the male organ.

Some men find it difficult to reach and maintain erections due to decreased blood flow. This condition is known as erectile dysfunction. It’s quite common.

Anxiety can be caused by even a single episode of erectile dysfunction. Fears that it will happen again may cause men to avoid sex, negatively impacting their relationships with their sexual partners.

Blood pressure(high) can also impair potency and decrease sexual desire. A few blood pressure medications may have comparable side effects.

Men should talk to their doctors about any concerns they have.

Read Testosterone Level by Age 

Challenges of Women’s BP on Sex

The impact of high blood pressure on sexual problems in women is not well understood. However, high blood pressure may have an impact on women’s sexual lives.

High blood pressure can decrease blood flow to the sexual organs and lower rates of nitric oxide, a chemical that aids in the relaxation of smooth muscles. It may result in the following symptoms in some women:

  • Reduced sexual drive or arousal
  • Having difficulty achieving sexual satisfaction
  • Dryness of the sexual organs
  • Using lubricant and learning techniques to increase arousal can be beneficial.

Women, like men, can experience anxiety and relationship problems as a result of sexual dysfunction. If a woman has any problems or concerns, she should consult her doctor.

Sexual Side Effect of High BP Drugs(Hypertensive Drugs)

Some high blood pressure prescription drugs may impair sexual drive or activity.

Tablets of water (diuretics). Diuretics can reduce forceful blood flow to the male organ, making erections difficult to achieve. They can also reduce the body of zinc, which is required for the production of the male hormone testosterone.

Beta-blockers are a type of medication that prevents the body from These medications, particularly older generation beta-blockers like propranolol (Inderal, Innopran XL), are frequently linked to sexual dysfunction.

Medication exactly as directed can help reduce the risk of side effects, including sexual issues. If that doesn’t work, talk to your doctor about other medications that may be less harmful.

Choosing High BP Drugs With Little Sexual Side Effects

Consult a doctor about your choices if you are taking blood pressure medicine and experiencing sexual side effects. Some blood pressure pills are less likely to interfere with sexual drive and activity. Changing to a newer type of beta-blocker, for instance, improves symptoms in some males and females.

If your doctor approves, you may be able to discontinue blood pressure medication for a short period of time to see if any sexual symptoms improve. Throughout this time, you may need to take blood pressure measurements at home on a regular basis to ensure that your blood pressure remains within a normal limit.

Inform your doctor about all medications you take, including herbal remedies and over-the-counter medications. Supplements, or a specific combination of pills or supplements, can sometimes cause sexual problems.

Relation of Sexual Arousal Drugs with High BP

Men taking into consideration erectile dysfunction medications should consult their doctors first. Sildenafil, vardenafil (Levitra, Staxyn), and tadalafil are erectile dysfunction medications (Cialis). The medication forms are generally regarded as safe for otherwise healthy men with high blood pressure.


Erectile dysfunction medications are not advised for men with severe cardiovascular disease or for men with high blood pressure who have difficulty urinating or have other lower urinary tract complications. Never combine erectile dysfunction medications with nitrates, which are commonly used to treat heart problems. This can result in a risky drop in blood pressure.

Sex BP Summery

The blood pressure level is quite different in men and women. Some factors are controlling this. We cannot just ignore this fact. For better physiological understanding and treatment procedures, we have to remember this.

High BP affects the sexual activity of men and women differently. Their treatment and diagnosis should be considered and chosen carefully.

Try not to take any medication without consulting a doctor, even not the OTC drugs.

Last Updated on February 23, 2022 by Learn From Doctor Team

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