Up until now, men’s and women’s blood pressure guidelines were matched. But new research suggests that normal blood pressure is not the same between the sexes.
According to a study authored by Susan Cheng, MD, MPH, MMSc,, associate professor of Cardiology at the Smidt Heart Institute, assuming the same guidelines could be harmful to a woman’s health. She advises the medical community to re-evaluate blood pressure guidelines that don’t account for differences in sex.
The systolic pressure measures the force of blood against the artery walls as the heart beats. It’s the first number in a blood pressure reading. Diastolic pressure is the second number, which measures the blood pressure against the walls between heartbeats.
The normal upper limit for systolic blood pressure in adults was 120 mmHg for years, though chronic increases above this level spell hypertension, a key risk factor for cardiovascular disease including heart attack, stroke and heart failure.
Cheng and her scientific team evaluated blood pressure measurements across four community-based cohort studies of over 27,000 subjects, of which 54% were women.
They discovered that the standard number of 120 mmHg was the threshold of risk for men but 100 mmHg or less was the threshold of risk for women. Systolic blood pressures higher than this were linked to the risk for the progression to cardiovascular disease including stroke, heart failure, and heart attack.
Investigators also found that women had a lower blood pressure threshold than men for risk of each specific cardiovascular disease type, including heart attack, heart failure, and stroke.
Cheng believes they need to reconsider what was once considered normal blood pressure to prevent men or women from developing heart disease or stroke. Cheng serves as director of Cardiovascular Population Sciences at the Barbra Streisand Women’s Heart Center. She is also the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science.
Previous research led by Cheng indicates that women’s blood vessels age more quickly than men’s. Her research confirms that women have different biology and physiology than men, which is why women may be at higher risk of getting certain types of cardiovascular disease throughout their lifetime.
Cheng and colleagues compared women to women and men to men instead of comparing the sexes to each other. “If the ideal physiologic range of blood pressure truly is lower for females than males, current approaches to using sex-agnostic targets for lowering elevated blood pressure need to be reassessed,” said Christine Albert, MD, MPH, chair of the Department of Cardiology at the Smidt Heart Institute. “This important work is far-reaching and has numerous clinical implications.”
Researchers next plan to evaluate if women should be treated for hypertension when their systolic blood pressure is above 110 mmHg but still below the level of 120 mmHg for men.
As a next step, researchers plan to study whether women should be treated for hypertension when their systolic blood pressure is higher than 110, but still lower than the systolic measurement of 120 for men.
Both men and women can help reduce their blood pressure by following the DASH diet guidelines. Below are some tips:
- Lose weight if overweight or obese. Losing just 10 pounds lowers blood pressure significantly.
- Fill up on fruits and vegetables. Go for dark green leafy vegetables and dark orange fruits or vegetables for more potassium.
- Choose low-fat dairy products when available. Calcium aids in blood pressure reduction.
- Limit intake of highly-processed foods like fast food, frozen meals, high-sodium snacks, breakfast and lunch meats, canned soup, etc. Cook without salt when possible.
- Include unsalted nuts and seeds and whole grains in your diet for magnesium.
- Move more. Regular exercise aids in blood pressure control.
- De-stress. Do some yoga, deep breathing exercises, or talk to a therapist. Stress raises blood pressure.
- Be moderate with alcohol. Alcohol is known to raise blood pressure. Aim for one drink/day for women, two drinks per day for men (or less).
- Get your ZZZs. Adequate sleep aids in blood pressure control.
- Take medication as prescribed. They call high blood pressure the “silent killer” because you may not notice symptoms until it’s too late. Heed your doctor’s advice if medicine is needed.
By Lisa Andrews, MEd, RD, LD
- Hongwei Ji, MD, Teemu J. Niiranen, MD Florian Rader, MD, MSc, Mir Henglin, BA, Andy Kim, BA Joseph E. Ebinger, MD, Brian Claggett, PhD, C. Noel Bairey Merz, MD and Susan Cheng, MD, MMSc, MPH. Sex Differences in Blood Pressure Associations With Cardiovascular Outcomes. Volume 143, Issue 7, 16 February 2021; Pages 761-763
- DASH Eating Plan | NHLBI, NIH
Stephanie Ronco has been editing for Food and Health Communications since 2011. She graduated from Colorado College magna cum laude with distinction in Comparative Literature. She was elected a member of Phi Beta Kappa in 2008.