Abstract Body (Do not enter title and authors here): Background: Sex differences in the burden and management of cardiovascular disease (CVD) risk factors persist despite widespread prevention guidelines. Our study examines sex differences in the prevalence, treatment, and control of hypertension (HTN) using real-world, electronic health patient data from a large integrated health system.

Methods: We conducted a retrospective cohort study using 2024 Northwell Health Allscripts TouchWorks electronic health record (EHR) system data. Adult patients (N = 268,167) with available EHR blood pressure (BP) measurements were included. We assessed stage of hypertension prevalence based on blood pressure levels; elevated BP defined as systolic BP 120-129 mmHg and diastolic BP <80 mmHg, Stage 1 HTN defined as systolic BP between 130-139 mmHg and/or diastolic BP between 80-89 mmHg and Stage 2 HTN defined as defined as systolic BP 140 mmHg and/or higher or diastolic BP 90 mmHg or higher. Hypertension was defined based on diagnosis codes, antihypertensive medication use, and/or measured systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg. For patients who were taking anti-hypertensive medications, we defined HTN control as systolic BP < 130 and diastolic BP < 80 mmHg. We employed age-adjusted linear and logistic regression models to assess sex differences with HTN prevalence, treatment and control.

Results: Overall, men had higher mean systolic (125.1 vs. 122.2 mmHg) and diastolic (75.5 vs. 74.9 mmHg) pressures than women (p < 0.05). Men had a higher prevalence of elevated BP, Stage 1 HTN and Stage 2 HTN compared with women (12.9 vs. 11.8%, 32.5 vs. 31.1% and 16.9 vs. 14.0%, respectively, p value < 0.05). Compared with women, men had a significantly higher prevalence of diagnosed HTN and a greater prevalence of anti-hypertensive use (figure). When treated with anti-hypertensive therapy, women were significantly less likely to have control of BP compared with men (figure).

Conclusions: Rates of HTN control in our cohort were relatively low overall. Despite a lower burden of diagnosed HTN, women in our large and diverse health system were less likely to experience HTN control than men. Our findings underscore the need for targeted, sex-specific approaches to improve cardiovascular risk factor management in clinical care.