What anti-hypertensive side effects are more common in women?

Antihypertensive Side Effects More Common in Women

Women are more likely than men to experience diuretic-induced hyponatremia and hypokalemia, ACE inhibitor-induced cough (twice as common), calcium channel blocker-related peripheral edema, and minoxidil-induced hirsutism. 1

Gender-Specific Adverse Effect Patterns

• Women generally report twice as many adverse effects from antihypertensive medications compared to men, as demonstrated in the TOMHS study 1
• Alpha-blockers are associated with a significantly higher risk of hypotension and hypotension-related events (including syncope) in women of advanced age compared to other blood pressure lowering medications 2
• For calcium channel blockers like amlodipine, clinical trials show a clear gender disparity in side effect incidence 3:
  • Edema: 14.6% in women vs. 5.6% in men (compared to 5.1% vs. 1.4% with placebo)
  • Flushing: 4.5% in women vs. 1.5% in men
  • Palpitations: 3.3% in women vs. 1.4% in men

Diuretic-Related Side Effects in Women

• Women are more likely to develop diuretic-induced hyponatremia than men 1
• Hypokalemia is more common in women taking diuretics 1
• Women are less likely to experience diuretic-induced gout compared to men 1
• Diuretics may provide additional benefit for elderly women by decreasing the risk of hip fracture 1

ACE Inhibitors and Other Medication Classes

• ACE inhibitor-induced cough occurs approximately twice as frequently in women compared to men 1
• Women are more likely to complain of calcium channel blocker-related peripheral edema 1
• Women report minoxidil-induced hirsutism more frequently than men 1
• For MRAs (mineralocorticoid receptor antagonists), men experience more adverse drug reactions than women, which is an exception to the general pattern 1

Clinical Implications and Recommendations

• When prescribing antihypertensive medications to women, be particularly vigilant for:

  • Electrolyte disturbances with diuretics (hyponatremia, hypokalemia) 1
  • Persistent cough with ACE inhibitors 1
  • Peripheral edema with calcium channel blockers 1
  • Hypotension and syncope with alpha-blockers, especially in elderly women 2

• For elderly women requiring multiple antihypertensive medications, consider avoiding alpha-blockers or using them with caution due to increased risk of hypotension and syncope 2

• Monitor electrolytes more closely in women taking diuretics, particularly sodium and potassium levels 1

• Consider alternative medication classes when women experience gender-specific side effects that impact quality of life or medication adherence 1

Special Considerations for Women of Childbearing Age

• ACE inhibitors and ARBs are contraindicated in women who are pregnant or planning pregnancy due to risk of fetal developmental abnormalities 1
• For women of childbearing age with hypertension who become pregnant, medications should be transitioned to methyldopa, nifedipine, and/or labetalol 1