Gender differences among patients with arterial hypertension and heart failure with preserved left ventricular ejection fraction

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K. M. Amosova
K. I. Cherniaieva
Yu. V. Rudenko
O. I. Rokyta
Z. V. Lysak
E. I. Levenko


The aim – assessment of gender differences in the frequency of comorbidities, structural and functional state of the heart, arterial stiffness, pulse load and ventricular-arterial interaction in patients with hypertension and heart failure with preserved left ventricular ejection fraction.
Material and methods. 115 patients were diagnosed with HFpEF II A or II B stage, II or III NYHA FC, with LV EF ≥ 50 % and signs of LV diastolic dysfunction by TTE, and were divided into 2 groups by gender (group 1 – women with AH and HFpEF, and group 2 – men with hypertension and HFpEF). The control group consisted of 58 patients matched for age, gender composition, with AH 1–2 degrees, without heart failure; they were also divided into 2 groups (groups 3 and 4, respectively).
Results. The examined groups of patients did not statistically differ regarding age and, among patients with HF, men and women did not differ in frequency of II or III FC (NYHA); among men, earlier MI was noted more frequently than in women – 23 (37.1 %) vs 4 (7.5 %) (P<0.001). BMI among women with or without HF was higher (30.3±5.4 vs. 29.8±4.6 and 32.0±4.5 vs. 30.0±3.2, P<0.05), without differences in the frequency of obesity. In women, the average GFR was lower – 61.2±13.5 vs. 74.4±15.2 and 70.6±1.3 vs. 86.1±17.9 (by 13.3 % and 18 %, respectively, P<0.001) Among patients with HFpEF, the prevalence of anemia was higher in women (16 (30.2 %) vs. 7 (11.3 %), P<0.05). The distance of the 6-minute walk test was significantly less in the group of patients with HF of both genders compared with the control group (353.4±91.6 vs. 553.2±56.6 and 384.3±83.5 vs. 569.8±33.7, P<0.01), with a slightly worse result among women (by 8 %, P<0.01). In women with HF, compared with men, there were elevated rates of both arterial elastance Ea — 2.3±0.6 vs.1.9±0.4, P<0.05 (by 17.4 %), and end-systolic stiffness Ees – 3.3±1.3 vs. 3.0±1.1, P<0.05 (by 9.1 %). Despite similar values of brachial BP and central BP in women with HF, compared to men, larger PWWc-f was noted by 9.5 % (12.8±1.5 vs. 12.2±1.4, P<0.05) and AIx75 by 9.2 % (37.7±12 1 vs. 34.7±8.9, P<0.05).
Conclusions. In the population of the examined patients with AH and HFpEF there is a tendency towards more pronounced diastolic LV dysfunction, severity of clinical manifestations of heart failure in women, in comparison with men, in the absence of gender differences. Women with HFpEF have a higher resistive and pulsative load on LV. Thus, in women with hypertension, there is an increased tendency to develop HFpEF compared to men.

Article Details


Артеріальна гіпертензія, серцева недостатність, діастолічна дисфункція, артеріальна жорсткість, стать, вік, Arterial hypertension, heart failure, diastolic dysfunction, arterial stiffness, gender, age.


"ATS Statement. Guidelines for the Six-Minute Walk Test". American Journal of Respiratory and Critical Care Medicine. 2002;166(1):111–117. doi: 10.1164/ajrccm.166.1.at1102

Anand IS, Rector TS. Pathogenesis of anemia in heart failure. Circ Heart Fail. 2014;7:699–700. doi: 10.1161/CIRCHEARTFAILURE.114.001645

Borlaug BA, Kass DA. Ventricular-vascular interaction in heart failure. Cardiol. Clin. 2011;29:447–459. doi: 10.1016/j.hfc.2007.10.001

Borlaug BA, Redfield MM. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011;123(18):13. doi: 10.1161/CIRCULATIONAHA.110.954388

Cleland JG, Pellicori P, Dierckx R. Clinical trials in patients with heart failure and preserved left ventricular ejection fraction. Heart Fail Clin. 2014;10:511–523. doi: 10.1016/j.hfc.2014.04.011.

Coutinho T, Borlaug BA, Pellikka PA, Turner ST, Kullo IJ. Sex differences in arterial stiffness and ventricular–arterial interactions. J. Am. Coll. Cardiol. 2013;61:96–103. doi: 10.1016/j.jacc.2012.08.997

Duca F, Zotter-Tufaro C, Kammerlander AA, Aschauer S, Binder Ch, Mascherbauer Ju, Bonderman D. Gender-related differences in heart failure with preserved ejection fraction. Sci Rep. 2018;8(1):1080-1089. doi: 10.1038/s41598-018-19507-7

Faconti L, Bruno RM, Buralli S, Barzacchi M, Dal Canto E, Ghiadoni L, Taddei. Arterial–ventricular coupling and parameters of vascular stiffness in hypertensive patients: Role of gender. JRSM Cardiovasc Dis. 2017;6:1–8. doi: [10.1177/2048004017692277]

Felker GM, Shaw LK, Stough WG, O'Connor CM. Anemia in patients with heart failure and preserved systolic function. Am Heart J. 2006;151:457– 462. DOI: 10.1016/j.ahj.2005.03.056

Gori M, Lam CS, Gupta DK, Santos AB, Cheng S, Shah AM, Claggett B, Zile MR, Kraigher-Krainer E, Pieske B, Voors AA, Packer M, Bransford T, Lefkowitz M, McMurray JJ, Solomon SD; PARAMOUNT Investigators. Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction. European Journal of Heart Failure. 2014;16:535–542. doi: 10.1002/ejhf.67.

Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308:875–881. doi: 10.1001/2012.jama.10503

Kim HL, Lim WH, Seo JB, Chung WY, Kim SH, Kim MA, Zo JH. Association between arterial stiffness and left ventricular diastolic function in relation to gender and age. Medicine. 2017;96(1):1–6. doi: [10.1097/MD.0000000000005783]

Ky B, French B, May Khan A, Plappert T, Wang A, Chirinos JA, Fang JC, Sweitzer NK, Borlaug BA, Kass DA, St John Sutton M, Cappola TP. Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. J. Am. Coll. Cardiol. 2013;62:72–1165. doi: 10.1016/j.jacc.2013.03.085.

Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13(1):18–28.

Lieber A, Millasseau S, Bourhis L, Blacher J, Protogerou A, Levy BI, Safar ME. Aortic wave reflection in women and men. Am J Physiol Heart Circ Physiol. 2010;299(1):236–242. doi: 10.1093/eurjhf/hfq121

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J. Am. Soc. Echocardiogr. 2009;22(2):107–133. doi: 10.1016/j.echo.2008.11.023.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2016;37(27):2129–2200. doi: 10.1093/eurheartj/ehw128

Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005;112:2254–2262. DOI: 10.1161/CIRCULATIONAHA.105.541078

Rusinaru D, Buiciuc O, Houpe D, Tribouilloy C. Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction. Int J Cardiol. 2011;147:278–282.

Savarese G, D’Amario D. Sex Differences in Heart Failure. Adv Exp Med Biol. 2018;1065:529–544. doi: 10.1007/978-3-319-77932-4_32.

Scantlebury DC, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Curr Opin Cardiol. 2011;26(6):562–568.

Shah SJ, Katz DH, Deo RC. Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction. Heart Fail Clin. 2014;10(3):407–418. doi: 10.1097/HCO.0b013e32834b7faf.

Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25:932–943. DOI: 10.1161/01.ATV.0000160548.78317.29

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