Definition and epidemiology of hypertensive cardiovascular disease in women: the size of the problem.

There remains a gap in our appreciation of gender differences that relate to the epidemiology of hypertensive cardiovascular disease. More women than men have hypertension. Cardiovascular disease, particularly coronary heart disease, is the leading cause of death in women in the industrialized countries of the world. The so-called female protection from coronary heart disease pertains primarily to young women. Indeed, there are risk factors such as diabetes that eliminate any gender advantage that women have over cardiovascular disease. There are also major gender differences in the clinical presentation of coronary heart disease. Women, until recently, have been under-represented in clinical trials, raising concerns as to the applicability of current guidelines for the diagnosis and treatment of hypertensive cardiovascular disease. This short review will highlight gender differences and similarities as noted in recent observational studies and intervention trials.