Evaluating Sex Differences in the Effect of Increased Systolic Blood Pressure on the Risk of Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis

Background: Cardiovascular disease (CVD) is a serious health concern worldwide, and half of the cases of CVD occur in Asia. Because hypertension or high blood pressure has been confirmed to be an important risk factor for CVD, controlling blood pressure is helpful for CVD prevention. Although many studies have shown a sex difference in the impact of blood pressure on the risk of CVD, the risk threshold of blood pressure remained the same for both sexes in the latest global guidelines. Objective: The study aimed to evaluate sex differences in the effect of increased blood pressure on the risk of CVD in Asian populations. Methods: In this study, we performed a systematic review via PubMed, Embase, and MEDLINE to select studies conducted with Asian populations published before 30 June 2021. Results: Six female and eleven male effect sizes for CVD risk from six articles were identified. The unadjusted pooled effect size for CVD risk per 10-mmHg increase in systolic blood pressure was estimated to be 1.20 for females (95% confidence interval: [1.10, 1.32]) and 1.19 for males (95% confidence interval: [1.11, 1.27]). Furthermore, using meta-regression to adjust for the significant effect of smoking, we showed that the impact of a 10-mmHg systolic blood pressure increase on CVD risk among females was 1.232 times that among males, corresponding to a significant sex difference (95% confidence interval: [1.065, 1.426]; 'P' = 0.02). In summary, the effect of an increased systolic blood pressure on the risk of CVD in females was significantly higher than that in males in the Asian population.