Women

Women make up 50% of the world’s population but the lack of equivalent representation in cardiovascular research studies makes them a “special population”. Women are more likely than men to be aware that they have hypertension, to have medical treatment, and to actually have their blood pressure under control. Oral contraceptive pills (OCPs) can cause elevated blood pressure in women. Women found to have high blood pressure should consider a trial discontinuation of OCPs and using an alternative form of contraception in order to assess if the OCPs are the cause. Women on OCPs should have their blood pressures assessed every six months. Data on the effect of menopause in blood pressure in women is controversial. The information is mixed and nothing has been stated conclusively. While women respond to antihypertensive drugs similarly to men, some special considerations may dictate treatment choices for women. ACE inhibitors and ARBs may not be a good choice in women of reproductive age and / or may be trying to get pregnant.

Minority Populations

In general, treatment is similar for all demographic groups but socioeconomic factors and lifestyle issues may be important barriers to BP control. BP control rates are lowest in Mexican Americans and Native Americans. Prevalence, severity, and impact of hypertension is increased in African Americans. African Americans demonstrate somewhat reduced BP responses to monotherapy with BBs, ACE inhibitors, or ARBs compared to diuretics or CCBs. These differences are usually eliminated by adding adequate doses of a diuretic. Furthermore, BB, ACE inhibitors, and ARBS still reduce morbidity and mortality from hypertension in African Americans (renal protection, cardio-protection) separately from the BP levels. African Americans are 2 – 4 x more likely to develop angioedema from ACE inhibitors than other groups.

Elderly

More than two-thirds of people over age 65 have hypertension. This population has the lowest rates of BP control. Treatment of the elderly, including those with isolated systolic hypertension, should follow same principles outlined for general care of hypertension. Lower initial drug doses may be indicated to avoid symptoms; but standard doses and multiple drugs will be needed to reach BP targets.  An elderly person starts at lower doses but ends up on as much blood pressure medication as a younger person to control their hypertension.

Other Special Populations

The Full JNC 7 Report covers other special situations regarding hypertension.

• Obesity and the metabolic syndrome
• Left ventricular hypertrophy
• Peripheral arterial disease
• Postural hypotension
• Dementia
• Hypertension in children and adolescents
• Hypertension urgencies and emergencies