Stronger Association Between Blood Pressure and Arterial Stiffness in Older Women than Men: The Hordaland Health Study.

Introduction: Sex differences in the life course development of brachial blood pressure (Bi et al. N Engl J Med, 2024. https://doi.org/10.1056/NEJMoa2412006 ) and the association between brachial and central BP are well documented.

Aim: To explore if the associations of brachial and central BP with the presence of increased arterial stiffness differ between older women and men.

Methods: Data from 1135 women and 943 men aged 68 in the Hordaland Health Study were used. Brachial BP was categorised as normal (BP< 130/85 mmHg), high-normal (BP 130-139/85-89 mmHg) or hypertension (BP≥140/90 mmHg). Arterial stiffness was assessed from carotid-femoral pulse wave velocity (cfPWV), and central systolic BP from brachial pulse wave analysis. Sex-specific associations between BP and increased arterial stiffness (cfPWV >10 m/s) were tested in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI).

Results: In multivariable analyses, both hypertension and high-normal BP were more strongly associated with presence of increased arterial stiffness in women (OR 5.81 [95% CI 3.86-8.75] and OR 2.56 [95% CI 1.43-4.56], respectively) compared to men (OR 2.56 [95% CI 1.43-4.56] and OR 2.01 [95% CI 1.22-3.33], both p for sex-interaction <0.05). Additionally, central systolic BP showed a stronger association with increased arterial stiffness in women (OR 1.06 [95% CI 1.05-1.07]) than in men (OR 1.05 [95% CI 1.04-1.06], p for sex-interaction <0.05).

Conclusions: In 68-year-old individuals, a high normal BP, hypertension and higher central systolic BP were all more strongly associated with the presence of increased arterial stiffness in women than in men.