Abstract
Objectives: Hypertension is the leading risk factor for cardiovascular disease. While treatment of high blood pressure is essential in cardiovascular disease prevention or slowing it down once cardiovascular disease occurred, it is assumed that pharmacological effectiveness may be hampered by sex differences. The aim is to evaluate sex-stratified effects for angiotensin-converting-enzyme inhibitors (ACEIs) on blood pressure and cardiac function in hypertensive participants.
Methods: A systematic review and meta-analysis were performed for studies on ACEIs from 1945 to May 2020. Studies had to present both baseline and follow-up measurements of the interested outcome variables and present sex stratified data. Mean differences were calculated using a random-effects model. 45 studies with 976 participants were used in this review.
Results: In females as compared to males, systolic blood pressure decreased by 19.9 mmHg (95% CI, -26.8; -13.0) vs. 15.1 mmHg (95% CI, -19.5; -10.8), diastolic blood pressure by 14.5 mmHg (95% CI, -17.2; -11.8) vs. 8.5 mmHg (95% CI, -11.4; -5.7), heart rate by -3.5 bpm (95% CI, -6.1; -0.9) vs. -2.5 bpm (95% CI, -4.8; -0.2). Only diastolic blood pressure lowered significantly more in females as compared to males. Left ventricular ejection fraction increased by 2.3% (95% CI, 0.8; 3.7) vs. 1.5% (95% CI, 0.6; 2.3), but without reaching statistical significance.
Conclusion: Although hypertensive treatment effects of ACEIs are comparable between sexes, diastolic blood pressure response is stronger in females, which may guide treatment choices in systolic or diastolic hypertension. It may be that other pharmacological different antihypertensive compounds show sex-specific differences in effectiveness.