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The gender effects in arterial hypertension (HT) epidemiology remain poorly clarified to date. We present an up-to-date review of the data regarding gender disparities in HT's prevalence, awareness, treatment, and control. Based on the data from three consecutive national-representative SEPHAR (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania) surveys conducted between 2005 and 2016, we provide insights into gender differences in HT's epidemiology and their 11- years the evolutionary trend in a high-CV risk European country. Our data displays gender effects in different age-dependent epidemiological patterns in terms of hypertension prevalence, awareness, treatment, and control, mainly due to hormonal status. Hypertension's prevalence is higher in younger men and older women. Although women are more often aware of their hypertensive condition and receive more often antihypertensive treatment, BP control is lower in older women compared to men of the same age, mainly due to a higher treatment side-effect rate. There is no solid evidence that different antihypertensive drugs exhibit different effects in lowering BP values between genders. In high CV risk European countries like Romania, if all the influencing conditions remain similar to those in the past 11 years, gender discrepancies in terms of HT's prevalence will diminish over time, awareness and treatment of hypertension will continue to be higher in females than in men, with an upward trend of BP control predicted only for women, while in men HT treatment control rate is expected to stagnate., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Ischemic heart disease (IHD) is the most important cause of mortality worldwide. Although the awareness of cardiovascular risk factors and IHD in women has increased over the last decades, mortality rates are still higher in women than in men. Among traditional cardiovascular risk factors, hypertension is associated with a greater risk for IHD in women as compared to men., Methods: In this review, discuss gender differences in epidemiology and pathophysiology of hypertension and its impact on the incidence and outcomes of IHD in women. We also, discuss some "women conditions" such as hypertensive disorders in pregnancy (HDP) and polycystic ovarian syndrome (PCOS). Even though this is not a systematic review, English-language studies on MEDLINE and the Cochrane Database of Systematic reviews were searched for consultation and analysis., Results: Hypertension display different epidemiological patterns in men and women. Studies have shown that hypertension has a different proatherogenic effects in men and women. Hypertension has a direct effect on microcirculation, but estrogens have a protective role in this regard in premenopausal women. However, after the decline in estrogen levels, women are exposed to the same cardiovascular risk as males. Postmenopausal women exhibit a greater burden of cardiovascular risk factors, which together with microvascular dysfunction and smaller and stiffer arteries conducts to the worse prognosis observed in women with IHD. "Women specific conditions" such as HDP and PCOS affects 10% of pregnant women and women in reproductive age, respectively. These conditions are associated with increased risk of hypertension and IHD later in life. Although women are more aware of their hypertension, cardiovascular mortality is higher in hypertensive women with comorbid IHD. Yet these gender disparities in outcomes seem to be attenuated with effective therapy., Conclusion: The pathophysiology of IHD is gender specific, women with ischemic symptoms presenting less often with coronary obstructive disease, and more frequently with dysfunction of the coronary microcirculation. Optimal control of hypertension could attenuate gender related differences in mortality in this population.

Objectives: to evaluate the hemodynamic profile of adults with hypertension, reflected by blood pressure (BP) and arterial stiffness measurements and identify factors associated with increased arterial stiffness. Material and methods. 798 adults identified in SEPHAR II survey were assessed by questionnaire interview, anthropometric measurements, blood pressure (SBP/DBP/PP), heart rate (HR) and arterial stiffness: aortic pulse wave velocity (PWVao), aortic augment index (AIXao) and systolic blood pressure (SBPao) measurements, ECG and laboratory work-up. Results. Mean and mod values of hemodynamic parameters are: SBP-149.96±20.49 mmHg, 146 mmHg; DBP-89.18±11.54 mmHg, 9? mmHg; PP - 60.99±17.95mmHg, 55mmHg; HR - 73.75±10.89 hpm, 74 hpm; PWVao 10.19±2.22, 9.80 m/s; AIXao -16.59%±39.17%, 52%; TASao 150.30±23.62 mmHg, 162mmHg. Factors associated with increased arterial stiffness are: over 60 years of age: [PWVao: rs =0.233; AIXao: rs =0.354; TASao: rs =0.284; p <0.0001], increased severity of HT [PWVao: rs =0.194; AIXao: rs =0.1744; TASao: rs =0.439; p < 0.0001], lack of BP control [PWVao: rs =0.213; AIXao: rs = 0.255; TASao: rs = 0.108] and the presence of at least one form of subclinical target organ damage [PWVao: rs-0.587; AIXao: rs "0.219; TASao: rs "0.192;]. Conclusions. Hemodynamic profile most commonly noted among romanian hypertensive adults is: TAS - 146 mmHg,TAD-92 mmHg, PP-55 mmHg, FC-74bpm, PWVao-9.8m,'s,AIXao52%TAsao, 162mmHg. Hypertensive adults with increased arterial stiffness often have over 60 years of age, a high degree of severity of the HTA, often are deprived of an optimal therapeutic control and assign at least one form of subclinical target organ damage. [ABSTRACT FROM AUTHOR]

Objectives - We thought to evaluate left atrium (LA) as an attempt to fi nd an echocardiographic marker of paroxysmal atrial fi brillation (AF) in hypertensive patients without any significant disease. Methods - We prospectively enrolled two groups of hypertensives: forty six patients with hypertension (HTN) without history of arrhythmia (group 1) and twenty three patients with HTN and a recent episode of documented paroxysmal AF (group 2). Left atrial (LA) diameters (anteroposterior, transversal and longitudinal) and LA phasic volumes (maximal, minimal and before atrial contraction) were assessed by 2D echocardiography and left atrial emptying functions (LAEF) (global, active and passive) were calculated; also 3D acquisitions of maximal and minimal volumes of LA were performed. Using the current recommendations of speckle tracking technique, peak longitudinal strain of left atrial walls (PALS) and peak atrial contraction strain (PACS) (mean value from apical four chambers and two chambers view) were analyzed. Results - Age (59.5y+-12 vs 67.7ys+-8, p=0.003) and the mean time of HTN diagnosis (42 mo+-6 vs 80 mo+8, p=0.007) were significantly higher in group 2; the other cardiovascular risk factors (smoking, dyslipidemia) were similar as prevalence. We found all 2D and 3D LA volumes significantly greater in group 2 (for all p<0.0001) and global, active and passive LA EF significantly lower in the same group, compared with the other (p<0.0001, p<0.0001 and p<0.02). In comparison with 2D values, 3D volumes and emptying fractions were lower, but with no statistical significance. The peak longitudinal strain values were also significantly lower in AF group versus HTN control (26.1+-7.4 vs 15.7+-5.6, p<0.0001) while peak contraction strain was nonsignificant in the two groups. Conclusion - The echocardiographic evaluation of LA function using 2D and 3D volumetric and speckle tracking methods can be successfully used in identifying hypertensive patients at risk of atrial fi brillation. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the predictive value of new cardiovascular (CV) risk factors for CV risk assessment in the adult Romanian hypertensive (HT) population. Methods: Hypertensive adults aged between 40-65 years of age, identified in national representative SEPHAR II survey were evaluated by anthropometric, BP and arterial stiffness measurements: aortic pulse wave velocity (PWVao), aortic augmentation index (AIXao), revers time (RT) and central systolic blood pressure (SBPao), 12 lead ECGs and laboratory workup. Values above the 4th quartile of mean SBP' standard deviation (s.d.) defined increased BP variability. Log(TG/HDL-cholesterol) defined atherogenic index of plasma (AIP). Serum uric acid levels above 5.70 mg/dl for women and 7.0 mg/dl for males defined hyperuricemia (HUA). CV risk was assessed based on SCORE chart for high CV risk countries. Binary logistic regression using a stepwise likelihood ratio method (adjustments for major confounders and colliniarity analysis) was used in order to validate predictors of high and very high CV risk class. Results: The mean SBP value of the study group was 148.46±19.61 mmHg. Over forty percent of hypertensives had a high and very high CV risk. Predictors of high/very high CV risk category validated by regression analysis were: increased visit-to-visit BP variability (OR: 2.49; 95%CI: 1.67-3.73), PWVao (OR: 1.12; 95%CI: 1.02-1.22), RT (OR: 0.95; 95% CI: 0.93-0.98), SBPao (OR: 1.01; 95%CI: 1.01-1.03) and AIP (OR: 7.08; 95%CI: 3.91-12.82). Conclusion: The results of our study suggests that the new CV risk factors such as increased BP variability, arterial stiffness indices and AIP are useful tools for a more accurate identification of hypertensives patients at high and very high CV risk. [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate left atrial (LA) structural and functional abnormalities in a group of optimal treated hypertensives, in comparison to a control group. Methods: This study included 35 prospectively enrolled subjects with treated, uncomplicated, essential hypertension (HTN). Left atrial diameters (anteroposterior, transversal and longitudinal) and left atrial phasic volumes [maximal (LAV max), minimal (LAV min) and before atrial contraction (LAVpreA)] were assessed by echocardiography and LA emptying functions (LAEF) (global, active and passive) were calculated. Using the current recommendations of speckle tracking technique, peak longitudinal strain of LA walls (PALS)(mean value from apical four chambers and two chambers view) were analysed. The results were compared with a group of 37 age-matched healthy controls. Results: LA anteroposterior diameter as well as all three phasic LA volumes were significantly greater in HTN group (39.54±4.6 mm vs 35.43±4.5 mm for anteroposterior diameter, 60.51±14.9 ml vs 45.22±13.4 ml for LAV max, 25.48±10.3 ml vs 14.64±5.3 ml for LAVmin and 42.14±11.4 vs 24.86±8.5 for LAVpreA , for all p<0.0001), while the transversal and longitudinal diameters were similar. We found significantly lower total and passive EF in hypertensives than in control group (total LAEF 49.78±8.4% vs 66.05±7.44, p<0.001and passive LAEF 44.62±8.36% vs 58.79± 8.14%, p<0.001), but the active LAEF was preserved. The peak systolic strain values were also significantly lower in HTN group versus control (22.7% versus 35.1%, p<0.0001) Conclusion: Hypertension, even correctly treated, affects the mechanical function of left atrium. In our hypertensive group we observed the dilation of left atrium and an altered passive and total atrial function, with preservation of atrial pump function compared to control group. LA dysfunction was also demonstrated through low peak strain values. [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate left atrial (LA) structural and functional abnormalities in a group of optimal treated hypertensives, in comparison to a control group. Methods: This study included 35 prospectively enrolled subjects with treated, uncomplicated, essential hypertension (HTN). Left atrial diameters (anteroposterior, transversal and longitudinal) and left atrial phasic volumes [maximal (LAV max), minimal (LAV min) and before atrial contraction (LAVpreA)] were assessed by echocardiography and LA emptying functions (LAEF) (global, active and passive) were calculated. Using the current recommendations of speckle tracking technique, peak longitudinal strain of LA walls (PALS)(mean value from apical four chambers and two chambers view) were analysed. The results were compared with a group of 37 age-matched healthy controls. Results: LA anteroposterior diameter as well as all three phasic LA volumes were significantly greater in HTN group (39.54±4.6 mm vs 35.43±4.5 mm for anteroposterior diameter, 60.51±14.9 ml vs 45.22±13.4 ml for LAV max, 25.48±10.3 ml vs 14.64±5.3 ml for LAVmin and 42.14±11.4 vs 24.86±8.5 for LAVpreA , for all p<0.0001), while the transversal and longitudinal diameters were similar. We found significantly lower total and passive EF in hypertensives than in control group (total LAEF 49.78±8.4% vs 66.05±7.44, p<0.001and passive LAEF 44.62±8.36% vs 58.79± 8.14%, p<0.001), but the active LAEF was preserved. The peak systolic strain values were also significantly lower in HTN group versus control (22.7% versus 35.1%, p<0.0001) Conclusion: Hypertension, even correctly treated, affects the mechanical function of left atrium. In our hypertensive group we observed the dilation of left atrium and an altered passive and total atrial function, with preservation of atrial pump function compared to control group. LA dysfunction was also demonstrated through low peak strain values. [ABSTRACT FROM AUTHOR]