Abstract 4145753: Gender Differences in Accelerated Vascular Aging in Patients with Resistant Hypertension

Background: RHTN is defined as blood pressure above goal in spite of using ≥3 antihypertensive agents. Patients with RHTN have significantly higher rates of cardiovascular disease (CVD). CVD is the number one cause of death for both men and women. Although premenopausal women are relatively protected from CVD, the incidence increases disproportionately in women after menopause. Arterial stiffening is a risk factor for the development of CVD and for all cause mortality independent of the presence of all traditional CVD risk factors. The association between arterial stiffness and mortality has been shown to be almost twofold higher in women compared to men. In addition, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction are the more commonly diagnosed forms of CVD in women and are associated with elevated arterial stiffness in women. Our study tries to identify the role of accelerated vascular aging (AVA) in female patients with RHTN compared to patients with HTN as a potential mechanism for higher rates of CVD and associated morbidity and mortality. Methods: We conducted a cross-sectional analysis of a large cohort of 965 patients with HTN and RHTN referred to the RHTN Clinic at the University of Alabama at Birmingham. Results: Women with RHTN compared to men had a similar duration of hypertension (20.6± 12.1 vs. 20.5 ±12.4 years, p=0.99), later onset of HTN (49.5 ± 13.4 vs. 45.5± 14.4 years, p=0.019), similar number of antihypertensive medications, similar levels of serum aldosterone, and plasma renin activity. However, women over the age of 55 with HTN had higher arterial stiffness (AS) than men with HTN (pulse pressure: 90.0±25.6 vs 68.8 ±23.3 mmHg, p<0.0001), and women with RHTN had higher AS than men with RHTN (pulse pressure: 90.0±25.6 vs 79.2±23.7 mmHg, p=0.0004). Furthermore, women with RHTN had higher AS than women with HTN. However, this was also true for men. Conclusion: The findings of our study suggest higher degree of accelerated vascular aging in women with RHTN despite later onset and similar duration of HTN compared to men. More evidence is needed to identify causes of accelerated aging in women older than 55 years of age.