A study published Wednesday looking at how blood pressure measurements change in men and women as they age offers new insights into why the two sexes experience heart disease in different ways.
Starting as early as young adulthood, women experience a steeper rise in blood pressure than men, the study found.
This suggests that, even though women tend to develop heart disease a decade later than men, the biological changes that may impact a woman's risk for certain types of the disease can start to show up in her 20s.
"Many of us in medicine have long believed that women simply 'catch up' to men in terms of their cardiovascular risk," Dr. Susan Cheng, an author of the study and the director of Public Health Research at the Smidt Heart Institute at the Cedars-Sinai Medical Center in Los Angeles, said in a statement.
"Our research not only confirms that women have different biology and physiology than their male counterparts, but also illustrates why it is that women may be more susceptible to developing certain types of cardiovascular disease and at different points in life," Cheng added.
The large, long-running study, published in the journal JAMA Cardiology, tracked nearly 33,000 people between the ages of 5 and 98 over more than four decades. Researchers observed sharper increases in blood pressure measurements for women starting in their 20s — increases that continued throughout their life span.
Cheng gave the example of a hypothetical 45-year-old woman and a 45-year-old man, who both show up at the doctor's office on the same day with a systolic blood pressure (the top number) of 140 mmHg. That reading would be considered hypertension, or high blood pressure, for both people.
The ways by which we think about and aim to prevent or treat high blood pressure likely needs to be more tailored, at least by sex.
But according to the new research, the woman's blood pressure rose more and rose faster over time than the man's to reach 140, she told NBC News in an email.
"The ways by which we think about and aim to prevent or treat high blood pressure likely needs to be more tailored, at least by sex," Cheng said. "But there's still have more work to do to understand exactly what the implications of this research are for outcomes and treatment."
Differences between men and women were found for both the top and the bottom numbers of blood pressure measurements, as well as a measurement of the pressure in arteries during a single heartbeat, called "mean arterial pressure."
Dr. Nieca Goldberg, a cardiologist and the medical director for the NYU Women's Heart Program and the senior adviser for women's health strategy at NYU Langone Health, said the study highlights the importance of monitoring blood pressure in women.
"We need to pay serious attention to blood pressure in everyone, but particularly in women," Goldberg, who was not involved with the new research, said.
High blood pressure can stiffen blood vessels, she said. That can lead to certain forms of cardiovascular disease that are more common in women, such as a condition called heart failure with preserved ejection fraction. That's when the heart can't fill properly with blood.
That, combined with belly fat — another factor that increases heart disease risk more in women than men — can cause thickening of the heart muscle, Goldberg told NBC News.
What's more, Goldberg said, pregnancy complications such as preeclampsia among women in their 20s and 30s are also known to increase the risk for high blood pressure later in life.
Anyone with a blood pressure measurement over 130/80 mm Hg is considered to have hypertension.
Last year, the Centers for Disease Control and Prevention reported a rise in heart disease death rates among women since 2011, particularly white women between the ages of 45 and 64. Even though overall, middle-aged men are more likely to die of heart disease than women of the same age, the increase in such death rates for women was found to be more than double the rate for men, according to the 2019 report.
"Younger to middle-aged adults especially need to be more aware that high blood pressure is not just a condition of older age — that it can begin at a younger age and, when it does, it is especially important to start treating," Cheng said.
Women of any age, even those in their 20s, can reduce their risk for heart disease in multiple ways.
First, cardiologists urge people to quit smoking. The link between smoking and heart disease is well established, but a 2018 study found that even one cigarette a day can raise the risk for heart disease and stroke, especially in women.
Second, exercise. Again, the benefits of physical activity are well established, but a recent study from Spain found that more sedentary women were nearly four times more likely to die from heart disease than the fittest women.
Third, watch what you're eating. Diets such as the Mediterranean diet that are rich in plants, lean proteins, seafood, nuts and seeds have been linked to good heart health, while ultraprocessed foods have been shown to increase the risk for heart disease.
Lastly, cut back on booze. Despite some previous indications that moderate alcohol intake may have a protective effect on the heart, Goldberg said heavy drinking can damage heart muscle. Indeed, a study published last year found as little as one drink a day can drive up blood pressure. And women are more vulnerable than men to the effects of alcohol.