Cardiovascular Therapy in Women with Hypertension or Heart Failure

There are sex/gender-related differences (SGRDs) in epidemiology, risk factors, pathophysiology, treatment, and outcomes of cardiovascular diseases as well as in body composition, sex hormonal regulation and drug pharmacokinetics (absorption, distribution, metabolism, and excretion). Thus, it shouldn’t be a surprise that women and men may respond differently to guideline-recommended drugs for the treatment of hypertension or heart failure (HTN/HF). However, the clinical relevance of SGRDs in the efficacy, safety and dosing of some guideline-recommended drugs remains uncertain because women were traditionally under-represented and a sex/gender-specific analysis of clinical results was not regularly performed in many randomized clinical trials. Therefore, many trials were underpowered to examine SGRDs in drug efficacy and safety even if they do exist. As a result, clinical practice guidelines recommend the same drugs and doses for the treatment of women and men with HTN/HF. Despite this recommendation, there is evidence of SGRDs in the clinical efficacy, safety (women develop more frequent and serious adverse reactions) and doses of some drugs used in these patients. A better understanding of the potential SGRDs, the pathophysiological mechanisms involved, and its clinical relevance is critical to optimize the treatment of HTN/HF and improve clinical outcomes in women. This chapter briefly summarizes SGRDs in the pharmacokinetics, efficacy, safety, and optimal doses of guideline-recommended drugs for the treatment of HTN/HF.