ABSTRACT
BACKGROUND: Several studies have shown gender differences in the management of cardiovascular risk factors and diseases. Whether the management of hypertension by cardiologists in France differs according to patient gender has not been fully investigated. AIMS: The main objective of this cross-sectional, multicentre study was to examine the management according to gender of hypertensive patients by office-based cardiologists in France. METHODS: Cardiologists were asked to include consecutively two men and two women attending a routine consultation for essential hypertension. Therapeutic management was evaluated by comparing cardiovascular investigations in the preceding 6 months and hypertension control according to gender and the patients' global cardiovascular risk. RESULTS: Overall, data from 3440 adult patients (53% men) referred to 654 cardiologists were analysed. Hypertension was uncontrolled in 76% of both men and women and 69% were at high global cardiovascular risk (75% of men, 62% of women; P<0.001). Significantly fewer cardiovascular investigations had been performed in the preceding 6 months in women (22.6% vs 44.2% in men; P<0.001). The treatment regimen was changed by the cardiologist in approximately 50% of patients regardless of gender or global cardiovascular risk. CONCLUSIONS: The PARITE study shows that in French office-based cardiology practice, the antihypertensive regimen is adjusted as often in female as in male patients. However, the results suggest that there is room for improvement in the investigation of cardiovascular disease in women. Healthcare providers could be encouraged to implement established guidelines on the prevention of cardiovascular disease in women.
Subject(s)
Antihypertensive Agents/therapeutic use , Cardiology/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hypertension/drug therapy , Practice Patterns, Physicians'/statistics & numerical data , Aged , Blood Pressure/drug effects , Chi-Square Distribution , Coronary Disease/etiology , Coronary Disease/prevention & control , Cross-Sectional Studies , Diagnostic Techniques, Cardiovascular , Drug Substitution , Drug Therapy, Combination , Female , France , Guideline Adherence/statistics & numerical data , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/physiopathology , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Office Visits/statistics & numerical data , Practice Guidelines as Topic , Predictive Value of Tests , Risk Assessment , Risk Factors , Sex Factors , Treatment OutcomeABSTRACT
The physiological effects of angiotensin II (Ang II) are mediated through specific AT(1) and AT(2) receptors. Tissue distribution and affinity of these receptors have been explored in binding studies, reverse transcriptase-polymerase chain reaction and in situ hybridisation. Sequencing has also demonstrated gene polymorphisms for both AT(1) and AT(2) receptors. Numerous potent nonpeptide antagonists of angiotensin converting enzyme or of AT receptors have been developed, thus providing a precise analysis of the physiology of the renin-angiotensin system. AT(1) receptors are widely expressed throughout adult tissues, while AT(2) receptors are mainly expressed in the fetus. Receptor density on the cell surface is regulated by multiple hormonal, cytokine and metabolic factors, and is thus profoundly affected by various pathological conditions, especially in the myocardium, kidney and blood vessels. To date, the precise molecular basis for these modifications has not been fully explained, although it may rely in part upon AT receptor gene polymorphisms, which could thus constitute increased risk factors for cardiovascular disease. AT(1) and AT(2) receptor expression is therefore influenced by both age and environmental specifications and is likely to be increased by a diet rich in salt or cholesterol, thus justifying the use of Ang II receptor antagonists in morbidity-mortality studies in high-risk patients.
