BACKGROUND:It is unclear whether sex-based differences in cardiovascular outcomes exist in late-onset hypertension.METHODS:This is a population-based cohort study in Ontario, Canada of 266 273 adults, aged ≥66 years with newly diagnosed hypertension. We determined the incidence of the primary composite cardiovascular outcome (myocardial infarction, stroke, and congestive heart failure), all-cause mortality, and cardiovascular death by sex using Cox proportional hazard models adjusted for demographic factors and comorbidities.RESULTS:The mean age of the total cohort was 74 years, and 135 531 (51%) were female. Over a median follow-up of 6.6 (4.7–9.0) years, females experienced a lower crude incidence rate (per 1000 person-years) than males for the primary composite cardiovascular outcome (287.3 versus 311.7), death (238.4 versus 251.4), and cardiovascular death (395.7 versus 439.6), P<0.001. The risk of primary composite cardiovascular outcome was lower among females (adjusted hazard ratio, 0.75 [95% CI, 0.73–0.76]; P<0.001) than in males. This was consistent after adjusting for the competing risk of all-cause death with a subdistributional hazard ratio, 0.88 ([95% CI, 0.86–0.91]; P<0.001).CONCLUSIONS:Females had a lower risk of cardiovascular outcomes compared with males within a population characterized by advanced age and new hypertension. Our results highlight that the severity of outcomes is influenced by sex in relation to the age at which hypertension is diagnosed. Further studies are required to identify sex-specific variations in the diagnosis and management of late-onset hypertension due to its high incidence in this group.

中文翻译：

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晚发性高血压老年人心血管结局与性别相关的差异

背景：尚不清楚迟发性高血压的心血管结局是否存在性别差异。方法：这是在加拿大安大略省进行的一项基于人群的队列研究，纳入了 266 273 名年龄≥66 岁的新诊断高血压成年人。我们使用针对人口因素和合并症进行调整的 Cox 比例风险模型，确定了主要复合心血管结局（心肌梗塞、中风和充血性心力衰竭）、全因死亡率和心血管死亡的发生率（按性别）。队列总年龄为 74 岁，其中 135 531 名 (51%) 为女性。在中位随访 6.6（4.7-9.0）年中，女性的主要复合心血管结局（287.3 比 311.7）、死亡（238.4 比 251.4）、和心血管死亡（395.7 比 439.6），P <0.001。女性主要复合心血管结局的风险低于男性（调整后风险比，0.75 [95% CI，0.73-0.76]；P <0.001）。调整全因死亡竞争风险后，亚分布风险比为 0.88（[95% CI，0.86–0.91]；P <0.001）。结论：与男性相比，女性心血管结局风险较低在以高龄和新发高血压为特征的人群中。我们的结果强调，结果的严重程度受到性别与高血压诊断年龄的影响。由于晚发性高血压的发病率较高，因此需要进一步的研究来确定迟发性高血压的诊断和治疗中的性别特异性差异。