Clinical research study
Sex Differences in Environmental and Genetic Factors for Hypertension

https://doi.org/10.1016/j.amjmed.2008.04.026Get rights and content

Abstract

Background

Sex differences are observed in many aspects of mammalian cardiovascular function and pathology. Hypertension is more common in men than in women of the same age. Although the effects of gonadal hormones on blood pressure are considered contributing factors, the reasons for sex differences in hypertension are still not fully understood. The present study was undertaken to compare the differences in several environmental and genetic factors beween men and women in the Hei Yi Zhuang, an isolated subgroup of the Zhuang minority in China.

Methods

Information on demography, diet, and lifestyle was collected in 835 women and 834 men aged 15 to 84 years. Genotyping of angiotensin-converting enzyme, adrenergic receptor β3, aldehyde dehydrogenase 2, calpastatin, connexin 37, hepatic lipase, lipoprotein lipase, peroxisome proliferator-activated receptor γ, thyrotropin-releasing hormone receptor, and von Willebrand factor also was performed in these subjects.

Results

The levels of systolic and diastolic blood pressure, and the prevalence, awareness, and treatment of hypertension were lower in women than in men (P < .05). Hypertension was positively associated with age, physical activity, alcohol consumption, body mass index, waist circumference, hyperlipidemia, total energy, total fat, sodium intake, and sodium/potassium ratio, and negatively associated with education level, total dietary fiber, potassium intake, angiotensin-converting enzyme, aldehyde dehydrogenase 2, and hepatic lipase genotypes in men (P < .05). Hypertension was positively associated with age, hyperlipidemia, total energy, total fat, sodium intake, sodium/potassium ratio, calpastatin, and von Willebrand factor genotypes, and negatively associated with education level, total dietary fiber, potassium, calcium intake, lipoprotein lipase, and thyrotropin-releasing hormone receptor genotypes in women (P < .05).

Conclusion

Sex differences in the prevalence of hypertension in the Hei Yi Zhuang population may be mainly attributed to the differences in dietary habits, lifestyle choices, sodium and potassium intakes, physical activity level, and some genetic polymorphisms.

Section snippets

Subjects

A total of 835 women and 834 men of Hei Yi Zhuang residing in 7 villages in Napo County, Guangxi, China, were surveyed by a stratified randomized cluster sampling. The ages of the subjects ranged from 15 to 84 years, with an average age of 46 years in both sexes. All study subjects were peasants. Approximately 3% of the total population was represented by this study sample. Persons with a history of chronic illness, including hepatic, renal, thyroid, myocardial infarction, stroke, congestive

Sex Differences in Demography, Diet, and Lifestyle

The differences in various demographic, dietary, and lifestyle characteristics were examined in hypertensive individuals compared with normotensive individuals, separately in men and in women (Table 1). The average age and the intakes of total energy, total fat, sodium, and sodium/potassium ratio in both sexes were higher in hypertensive individuals than in normotensive individuals, whereas educational level, total dietary fiber, and potassium intake were lower in hypertensive individuals than

Demographic, Lifestyle Characteristics, and Hypertension

The present study shows that the levels of systolic and diastolic blood pressure, and the prevalence of hypertension were lower in women than in men, whereas the average age in hypertensive individuals was higher in women than in men. These findings are in agreement with those of several previous studies in other populations.20, 21 Sex differences in blood pressure are affected by multiple environmental and genetic factors. We found that the levels of systolic and diastolic blood pressure in

Limitations

There are some potential limitations of this study. First, we were not able to detect the levels of urinary sodium, potassium, and other electrolytes. These variables detected from 24-hour urine samples may be more precise than those calculated from the 24-hour dietary recall method.44 Second, we could not measure the levels of gonadal hormones. Sex steroids have been suggested to have an important impact on blood pressure.45 Finally, blood pressure is affected by multiple environmental,

Conclusions

Hypertension is more prevalent in the Hei Yi Zhuang population. The sex differences in the prevalence of hypertension may be mainly attributed to the differences in dietary habits, lifestyle choices, sodium and potassium intakes, physical activity level, and genetic factors. The rates of awareness, treatment, and control of hypertension were relatively low, especially in women. These results underscore the urgent need for developing a high blood pressure education program to coordinate the

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    This study was supported by the National Natural Science Foundation of China (No. 30360038).

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