Sex differences of angiotensin-converting enzyme inhibitors in blood pressure lowering and cardiac remodeling: a systematic review and meta-analysis

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Published Nov 20, 2023
DOI: https://doi.org/10.18103/mra.v11i10.4306

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Sophie A.J.S. Laven, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Daniek A.M. Meijs, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands;
Zenab Mohseni-Alsalhi, MSc
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Eveline M. van Luik, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Maud A.M. Vesseur, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Esmée W.P. Vaes, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Nick Wilmes, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands;
Sander de Haas, MSc, MD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands;
Marc E.A. Spaanderman, MD, PhD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, the Netherlands;
Chahinda Ghossein-Doha, MD, PhD
Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands; Department of Cardiology, Maastricht University Medical Center (MUMC+), the Netherlands;

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.

Keywords: hypertension, cardiovascular disease, antihypertensive drugs, angiotensin-converting-enzyme inhibitors, sex differences

Article Details

How to Cite
LAVEN, Sophie A.J.S. et al. Sex differences of angiotensin-converting enzyme inhibitors in blood pressure lowering and cardiac remodeling: a systematic review and meta-analysis. Medical Research Archives, [S.l.], v. 11, n. 10, nov. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4306>. Date accessed: 11 dec. 2023. doi: https://doi.org/10.18103/mra.v11i10.4306.
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Issue
Vol 11 No 10 (2023): October Issue, Vol.11, Issue 10
Section
Review Articles

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