Biological Sex and Cardiovascular Disease Prevention in Systemic Arterial Hypertension

Biological sex influences the life course development of blood pressure, systemic arterial hypertension, and hypertension-associated complications through neural, hormonal, renal, and epigenetic mechanisms. Sex hormones influence blood pressure regulation through interaction with several main regulatory systems, including the autonomic nervous system, the renin-angiotensin-aldosterone system, endothelin, and renal mechanisms. The modulation of vascular function by sex hormones varies over the lifespan. A more progressive decline in vascular endothelial function and an increase in vascular remodeling and arterial stiffness with aging are found in female individuals. Epigenetic mechanisms, including DNA methylation, histone modifications, and noncoding microRNAs, may be implicated in systemic arterial hypertension development and complications. Overall, current knowledge highlights the importance of including biological sex as a critical factor in understanding systemic arterial hypertension pathophysiology and advancing cardiovascular prevention.