The Present and Future
State-of-the-Art Review
Hypertension Across a Woman’s Life Cycle

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Abstract

Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.

Key Words

hypertension
pregnancy-related hypertension
prevention
race and ethnicity
women

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
ARB
angiotensin receptor blocker
BP
blood pressure
CCB
calcium-channel blocker
CHC
combined hormonal contraceptives
CVD
cardiovascular disease
HTN
hypertension
OCs
oral contraceptive pills
PE
pre-eclampsia
SNS
sympathetic nervous system

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The authors of this work were supported by contracts N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, RO1-HL-073412-01, U0164829, U01 HL649141, and U01 HL649241 from the National Heart, Lung, and Blood Institute (NHLBI); grants from the Gustavus and Louis Pfeiffer Research Foundation, The Women's Guild of Cedars-Sinai Medical Center, The Ladies Hospital Aid Society of Western Pennsylvania, and QMED, Inc. (Laurence Harbor, New Jersey); and by the Edythe L. Broad Endowment, the Barbra Streisand Women's Cardiovascular Research and Education Program, the Linda Joy Pollin Women's Heart Health Program, Cedars-Sinai Medical Center, and the Emory Women's Heart Center, Emory University School of Medicine. The authors of this document are a writing group from the Cardiovascular Disease in Women Committee of the American College of Cardiology. The contents of this paper are solely the responsibility of the authors and do not necessarily reflect the official views of the NHLBI, the National Institutes of Health, or the U.S. Government. Dr. Wenger has served as a consultant for Amgen, AstraZeneca, Gilead Sciences, and Merck; and has received research grants from Alnylam Pharmaceuticals, Gilead Sciences, the NHLBI, Pfizer, and the Society for Women's Health Research. Dr. Bairey Merz has been a consultant for and has received honoraria from the Annenberg Center for Health Science, American Diabetes Association, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study, Expert Exchange, Japanese Circulation Society, Kaiser, Mayo, Northwestern, Pacific Medical Center, Practice Point Communications, Pri-Med, Sanofi, University of Colorado, University of California–San Francisco, University of Utah, Women’s Health Congress, WomenHeart, ACRWH, New York University, San Bernardino, University of California–San Diego, National Institutes of Health Study section service for Cancer, Cardiovascular, Sleep Epidemiology, and the Research Triangle Institute. Dr. Cooper-DeHoff has received funding from the National Institutes of Health Pharmacogenomics Research Network (grant U01-GM074492). Dr. Ferdinand has received grant and/or research support from Boehringer Ingelheim; and has been a consultant for Novartis, Amgen, Sanofi, Boehringer Ingelheim, Eli Lilly, and Quantum Genomics. Dr. Pepine has received grant support from the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine, the National Institutes of Health, National Center for Advancing Translational Sciences—University of Florida Clinical and Translational Science (UL1TR001427), PCORnet-OneFlorida Clinical Research Consortium (CDRN-1501-26692), and the U.S. Department of Defense (CDMRP PR161603); and has received grant support from Adelphi Values, Amgen, AstraZeneca, Athersys, Boehringer Ingelheim, Brigham and Women’s Hospital, Capricor Inc., Cytori Therapeutics, Daiichi-Sankyo, the Department of Defense, Duke University, Gilead Sciences, Inc., inVentive Health Clinical LLC, Merck & Co., National Institutes of Health/NHLBI, Minocycline HTN, Microbiota HTN, Microbiota, Relypsa, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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