Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study

Background

Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management.

Objective

To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era.

Methods

Design: Retrospective population-based cohort study.

Setting: Ontario, Canada.

Participants: Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017.

Exposure: Sex (female vs. male).

Outcomes and Measures: We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression.

Results

Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99–1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83–1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96–0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994–0.997]).

Conclusions

Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.