Compared with men, women have unique risk factors for developing hypertension and special challenges in keeping blood pressure under control, according to a special issue published online February 7 by Hypertension.

"Our goals were to help convey the importance of prevention and treatment of hypertension and cardiovascular disease in women, to emphasize that hypertension is a critical cardiovascular risk factor in women, and to publish the newest and best research related to hypertension in women," said John E. Hall, PhD, Hypertension Editor-in-Chief.

The issue features more than 45 studies related to hypertension in women. Data from the American Heart Association Heart Disease and Stroke Statistics - 2008 Update shows that high blood pressure kills significantly more women than men and is two to three times more common in women who take oral contraceptives than in women who do not. Previous studies also show that about 60 percent of women with hypertension are treated; among women who are treated, only a third maintain blood pressure at optimal levels.

A number of key articles were discussed individually. In a study of 28,888 American women, age 45 years or older, researchers found that risk of new-onset hypertension decreased with higher intake of low-fat dietary calcium and dietary vitamin D, remained stable with calcium or vitamin D supplements, and increased with high-fat dairy product intake. That study had 8710 cases of hypertension diagnosed during the 10-year follow-up period.

In a brief review accompanying several pregnancy-related studies, researchers noted that hypertension is the most common medical disorder of pregnancy, complicating 1 in 10 pregnancies. They emphasized the importance of diagnosis in differentiating between pre-existing hypertension and pregnancy-induced hypertension and preeclampsia. They supported recommendations that pregnant women and those planning to become pregnant should avoid angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Acceptable alternatives may include methyldopa, labetalol and nifedipine, in standard doses to manage hypertension in pregnancy.

Researchers in the United Kingdom found that, while cigarette smoking during preeclamptic pregnancies further increased risks, stopping smoking could decrease risks. A multicenter, cohort study of 1,001 white Western European women and their babies found that, compared with women who never smoked, the women who currently smoked were more likely to deliver before 34 weeks, more likely to deliver lower birthweight babies or have babies with an adverse outcome, and were more likely to develop eclampsia.

Women who had previously smoked and stopped prior to or during their pregnancy also significantly decreased their risks. Among current smokers, 34.8 percent delivered before 34 weeks (compared with 26.8 percent of former smokers and 21.3 percent of non-smokers), 46.1 percent had low birthweight babies (compared with 37.5 percent of former smokers and 27.9 percent of non-smokers) and 65.6 percent had babies who experienced adverse outcomes (compared with 60 percent of former smokers and 50.4 percent of non-smokers).

Two separate studies in the United States found persistent gender disparities in blood pressure control and cardiovascular disease management.

From the 1999-2004 National Health and Nutrition Examination Study, researchers analyzed data on 3,475 people, age 18 years or older with hypertension. While blood pressure control in women and men was comparable (55.9 percent uncontrolled in women and 50.8 percent in men), the prevalence of central obesity, elevated total cholesterol level and low high-density lipoprotein-cholesterol were found to be significantly higher in women than in men. Those age adjusted risk factors included central obesity (79 percent women vs. 63.9 percent men), elevated total cholesterol level (61.3 percent women vs. 48 percent men) and low high-density lipoprotein (LDL or "bad") cholesterol (39.7 women vs. 35.6 men.)

Using data from the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, researchers analyzed data from 12,064 patient visits (7,786 women, 4,275 men). They found that among patients with hypertension, women were less likely than men to meet blood pressure control targets (54 percent vs. 58.7 percent), receive aspirin (20.7 percent vs. 35.5 percent), receive beta blockers (31.9 percent vs. 44.5 percent) or receive statins (28.5 percent vs. 35.3 percent) for secondary prevention of cardiovascular disease.

Less than half (20.7 percent of women, 46.6 percent of men) of all patients received recommended therapy across all conditions considered important contributors to hypertension and cardiovascular disease.