Abstract Body: Background Recent studies reported higher coronary heart disease (CHD) risk at lower blood pressure (BP) in females than males, implying a need for sex-specific hypertension (HTN) thresholds. Whether these observations apply to diagnosis thresholds and/or treatment targets remains unclear.

Objectives To determine whether CHD risk differs by BP levels between males and females according to HTN treatment status.

Methods The ARIC Study measured seated BP during Visit 1 (1987-1989), averaging the second and third of three measurements. HTN treatment was determined based on pill-bottle review. We excluded participants with a history of CHD, heart failure, or stroke. Incident CHD events were adjudicated. We examined 10-year CHD risk scores using the PREVENT risk estimator, CHD incidence rates (IR), and the hazard ratios (HR) of CHD events via the Pooled Estimating Equation, Poisson regression, and Cox proportional hazard models, controlling for CHD risk factors (Table Footnote).

Results Of 13,426 participants (56% female, mean age [54±5.7 years]), 25% were treated for HTN. Males in both groups had higher average 10-year CHD risk scores across SBP categories than females (P comparing trends <0.001) (Table). While IRs were lower among females in the untreated group, they did not differ significantly from males in treated participants (P comparing trends > 0.05). Notably, while similar in untreated populations, treated females may experience higher risk (HR) of incidence CHD events than treated males across all SBP categories.

Conclusion While there were differences in absolute and relative risk of CHD between males and females, we did not find consistent evidence that untreated males and females experience different risk of CHD risk by SBP threshold. These findings do not support a sex-specific threshold for hypertension diagnosis or treatment.