Figure 1.

Pathophysiological background of sex-related differences in hypertension. CV, cardiovascular; RAAS, renin-angiotensin-aldosterone system. Sex-related differences in hypertension are mostly explained by the beneficial action of estrogens, promoting vasorelaxation and sympathoinhibition, preventing vascular remodeling, and providing renoprotection. Estrogens also alter the balance between the vasoconstricting and vasodilating arms of the renin-angiotensin-aldosterone system, favoring vasodilation. After menopause, these beneficial effects disappear, and the arterial wall rigidity increases. Apart from that, due to a shorter stature, women have a shorter arterial tree than men, which may lead to amplification of peak systolic blood pressure by the reflected waves.