Grant: Travel Awards - Institute Community Support

Hypertension is the leading risk factor for cardiovascular mortality, with sex- and gender-based differences. However, clinical recommendations for hypertension management remain sex- and gender-blind. We assessed the incorporation of sex and gender reporting in the literature informing hypertension guidelines. Literature cited in the International Society of Hypertension, European Society of Cardiology/European Society of Hypertension, American College of Cardiology/American Heart Association, Latin American Society of Hypertension, Pan-African Society of Cardiology, Hypertension Canada guidelines were systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation-to-prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were abstracted. Of 1,659 unique studies, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male to female PPR of 0.8-1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. While 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. A majority (58%) of studies reporting sex/gender used sex and gender terms interchangeably. Incorporation of sex- and gender-based considerations in study population, analysis or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex- and gender-based factors in research is required to optimally inform management of hypertension.