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.