Treating hypertension in women: open-ended questions and therapeutic options.

Early intervention studies have challenged the notion that lowering blood pressure is beneficial in women with mild hypertension. In contrast, results of more recent trials have clearly shown that treatment of hypertension is of benefit in women, particularly in elderly women. Aggressive treatment of hypertension is advisable in this subset of the population that is exposed to a greater risk of hypertension-related cardiovascular diseases because of the greater prevalence of hypertension and of its inadequate treatment. Hypertensive women are preferentially treated with diuretics but the rationale for this therapeutic selection is unclear. Calcium antagonists, beta-blockers and angiotensin-converting enzyme inhibitors exert an antihypertensive action similar to that of diuretics, but their use is limited by the adverse effects that are more frequent in women than in men. Angiotensin II receptor antagonists, being effective in lowering blood pressure and particularly well tolerated, may represent, in the future, the first-line drugs for treating hypertension in women.