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.