SEX DIFFERENCES IN BLOOD PRESSURE BY AGE AND MENOPAUSE STATUS AND CARDIOVASCULAR DISEASE IN THE UK BIOBANK

Objective: This study sought to examine whether the sex-differential association between blood pressure (BP) and cardiovascular disease (CVD) differs by age, and the effect that menopause has on the BP-CVD relationship in women.Design and method: 420,649 UK Biobank participants with no prior history of CVD were included. Sex-specific relative risks (RRs) with 95% confidence intervals (CIs) relating systolic BP (SBP), diastolic BP (DBP) and hypertension vs no hypertension to CVD were estimated using Cox regression by age group (<50, 50-<55, 55-<60, and >=60 years) including a three-way interaction between sex, age group, and the BP exposure of interest to the models. Similarly, subgroup analyses were conducted by menopausal status (pre-menopausal, menopausal) in women. Results: RRs were greater for the associations between BP and incident CVD among younger age groups for both sexes. The RR for CVD per 10mmHg in SBP for women <50 years was 1.29 (1.24, 1.33) compared with their men counterparts [1.22 (1.19, 1.25)]. The corresponding RR for women >=60 years was 1.11 (1.09, 1.12) and for men 1.09 (1.08, 1.10). The RR’s for CVD per 5 mmHg in DBP followed similar results to SBP, for women <50 years the RR was 1.24 (1.21, 1.28) compared with their men counterparts [1.19 (1.17, 1.21)]. The corresponding RR for women >=60 years was 1.05 (1.04, 1.07) and for men 1.04 (1.03, 1.05). The RR of CVD for pre-menopausal women per 10 mmHg in SBP was higher 1.30 (1.24,1.35) compared with menopausal women 1.13 (1.12,1.14). The effect of having hypertension vs no hypertension on CVD was also higher in pre-menopausal 2.39 (2.02, 2.83) vs menopausal women 1.52 (1.44, 1.60). Conclusions: The present study found that higher BP was associated with larger RRs for CVD among women that were pre-menopausal or younger (<55 years). The influence of age on the relationship between BP and CVD was more pronounced among women than men, with differences between age, sex and BP observed for all BP metrics.