ACE inhibitors (Manipal Institute of Technology)

Peripheral artery disease (PAD) has traditionally been identified as a male-dominant disease; however, current literature suggests that female patients may be at increased risk of adverse outcomes. Given the key differences between sexes, we conducted a retrospective review to identify presurgery risk predictors that may increase morbidity within the female PAD population.

Data were extracted from the Vascular Quality Initiative database for patients who underwent suprainguinal or infrainguinal bypass surgery for PAD between 2009 and 2020. Binary logistic regression was used to assess for sex differences in risk predictors, drug administration characteristics, and postoperative outcomes; analysis was adjusted for potential covariates.

A total of 79,981 patients were included based on our eligibility criteria, 34% of which were female. Female patients typically presented at an older age, were more frequently hypertensive and diabetic, and were significantly less likely to be prescribed angiotensin-converting enzyme inhibitors, anticoagulants, and statin preoperatively. Women had a significantly higher postoperative risk of all-cause morbidity (1.06 [1.03, 1.09];P = 0.004), mortality (1.09 [1.05, 1.13];P < 0.001), stroke (1.48 [1.35, 1.62];P < 0.001), and major adverse cardiovascular events (1.19 [1.10, 1.28];P < 0.001) when compared to male patients. No preoperative statin use was a significantly greater predictor for all-cause morbidity in women.

Following surgery for PAD, our results suggest that female patients have a significantly greater risk of adverse outcomes as compared to male patients. Reduced administration of key medication including statin and angiotensin-converting enzyme inhibitors along with a greater comorbidity burden in female patients may be major contributors to this greater morbidity risk.

Pharmacological prescription guidelines for hypertension lack differentiation between the sexes, despite reported sex differences in prevalence, awareness, pathophysiology, and pharmacological response.

To assess prescription patterns of blood pressure-lowering medication among females and males in primary care.

In this observational study, which was undertaken in the Netherlands, we analysed data collected in 2018 during routine primary care practice among those pharmacologically treated for elevated blood pressure, and free from cardiovascular comorbidities or diabetes mellitus.

We assessed sex differences in the number of prescribed drugs, defined daily dosage, type of antihypertensive medication, and blood pressure control. We adjusted for differences between sexes in age and other covariates.

This study included 8596 females and 5788 males. Both females and males were prescribed on average 1.8 antihypertensive agents per person. Females compared with males were prescribed a significantly lower defined daily dosage (1.8 versus 2.1, P <0.001), more often received beta-blockers (35.4% versus 26.3%, P <0.001) and diuretics (53.7% versus 50.5%, P <0.001), while receiving fewer angiotensin-converting enzyme (ACE) inhibitors (35.4% versus 46.3%, P <0.001), and calcium channel blockers (28.5% versus 35.6%, P <0.001). No sex differences were found for angiotensin receptor blockers (24.3 versus 24.4%, P = 0.842). Importantly, females had significantly better controlled hypertension than males (50.2% versus 45.5%, P <0.001).

In those pharmacologically treated for elevated blood pressure, differences between females and males exist in defined daily dosage, type of antihypertensive medication, and blood pressure control, with females achieving better hypertension control than males with different type of medication and lower dosage.