• Ann Bugeja, Celine Girard, Manish M Sood, Claire E Kendall, Ally Sweet, Ria Singla, Pouya Motazedian, Amanda J Vinson, Marcel Ruzicka, Gregory L Hundemer, Greg Knoll, and Daniel I McIsaac.
• Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
• J. Intern. Med. 2024 Sep 1; 296 (3): 280290280-290.

BackgroundSex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management.ObjectiveTo compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era.MethodsDesign: Retrospective population-based cohort study.SettingOntario, Canada.ParticipantsResidents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017.ExposureSex (female vs. male).Outcomes And MeasuresWe used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression.ResultsAmong 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99-1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83-1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96-0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994-0.997]).ConclusionsCompared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.© 2024 The Author(s). Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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