Researchers report that women have a greater burden of hypertension than their male counterparts and they receive more aggressive treatment for it, yet they obtain no better blood pressure control.

In addition, the researchers say that the impact of hypertension on mortality or recurrent cardiac events was similar between men and women.

Reporting their findings at the annual scientific session of the American Heart Association, the Duke University scientists say there are great opportunities to improve medical therapy and outcomes in women.

Cardiologist Kristin Newby, of the Duke Clinical Research Institute, wanted to know how the prevalence and treatment of hypertension varied between the sexes in patients who came to the hospital with an acute coronary syndrome (ACS). ACS refers to a sudden and severe heart condition resulting from a clot narrowing or blocking a coronary artery that requires aggressive treatment but may not have developed into a full-blown heart attack. When a patient with sudden onset of chest pain arrives in the hospital, the physician must quickly determine whether the symptoms are due to unstable angina or a frank heart attack.

Hypertension is an independent risk factor for death or further cardiac events after ACS, Dr. Newby explains. But when you adjust for factors such as age, kidney function, diabetes, or other heart problems, the risks turn out to be about the same.

"The difference in outcomes does not appear to be due totally to gender, but at least in part to these and other factors," Dr. Newby says.

Dr. Franz Messerli of the Ochsner Clinic Foundation Hospital in New Orleans, says, "It's harder for women to get to the goals [normal blood pressure readings], but despite that, women do remarkably well."

An encouraging finding, Dr. Messerli says, is that even though women received intense antihypertensive therapy and were not as well-controlled as men, "their outcomes are about the same."

To conduct the study, Dr. Newby consulted data gathered from two related international trials - SYMPHONY and 2nd SYMPHONY (Sibrafabin vs. aspirin to yield maximum protection from ischemic heart events post-acute coronary syndromes)

While these trials were designed to compare the effectiveness of aspirin to a new class of drugs that dissolves blood clots, researchers at the 931 participating centers also collected data on each patient's medication history and outcomes.

Dr. Newby's analysis included 2,091 women and 5,084 men enrolled in the SYMPHONY trials in the US. She found that 63 percent of women had hypertension, compared to 50 percent of the men. The women with hypertension tended to be older, had reduced kidney function, and more often had diabetes and a history of heart failure when compared to men.

However, women had fewer previous heart attacks or invasive procedures to improve blood flow to the heart.

"What we found so interesting was that women received more and different agents to reduce blood pressure than did the men," Dr. Newby said. "What is confusing is that this difference in the number of drugs to control hypertension still did not have any significant effect, when compared to the men."

The classes of medications used most often to control blood pressure were ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics.

Specifically, 16 percent of the women required three different medications to control hypertension, compared to 13 percent for men. Almost 35 percent of women received two different medications, compared to 30 percent for men.

Only one type of medication, diuretics, appeared to be prescribed to women more often than to men - 33 percent in women compared to 19 percent in men.

"While women were more likely to get multi-drug treatments, they still had higher blood pressures," Dr. Newby says. Systolic pressure was 150 millimeters of mercury (mmHg) at presentation in women and 147 mmHg in men, she reports.

Even after treatment for the ACS, blood pressure remained higher in women (126 mmHg vs. 124 mmHg in men).

"Thus, it is not clear if women are not getting the right medicines, are getting them in the wrong doses, or if other factors are responsible for the need for more medications in women to attain similar control," Dr. Newby says.

Dr. Newby says that physicians need to be aggressive in treating hypertension, whether their patients are male or female. She added that awareness of the disease, both on the part of physicians and patients, is important to reducing the prevalence of hypertension and therefore reduce the risk for heart attacks.

"Hypertension is often forgotten about, a silent disease," she says. "Awareness may be the key, since the disease itself does not make patients feel bad. A lack of awareness affects compliance with medications, going to the doctor for check-ups, eating healthful meals, all those things that are helpful in keeping hypertension in control."

Always consult your physician for a diagnosis.