SEX-DIFFERENCES IN THE RESPONSE OF BLOOD-PRESSURE TO MODERNIZATION

Sex and age differences in the incidence of hypertension and blood pre ssure (BP) levels and their concomitants are examined among the Manus of Papua New Guinea in the context of modernization. For Manus men, BP increases directly with both degree of modernization and duration of migration to the local towns and larger cities of Papua New Guinea, ac companied by similar increases in body mass and subcutaneous fat. For Manus women, however, although body mass and fatness increase along th e modernization continuum, BP does not. Risk for hypertension (140/90 mm Hg) was increased fourfold among men who resided in town (adjusted odds ratio [AOR] = 4.4, 95% confidence interval [CI] 1.5-13.2) and als o among those who were in the highest tertile of fatness (AOR = 4.1, 9 5% CI 1.6-10.4). Among women, older age (greater-than-or-equal-to 45) alone significantly increased risk tenfold (AOR = 10.5, 95% CI 1.7-66. 8). Using a Mantel-Haenszel Chi2, a meta-analysis of sex and age diffe rences in relative risk for hypertension (160/95 mm Hg) among 20 Pacif ic populations, 9 traditional living and 11 undergoing modernization, was performed. While young men showed increased risk in modernizing po pulations (summary relative risk [SRR] = 1.34, 95% CI 1.12-1.60), olde r men had significantly reduced risk for hypertension compared with wo men in both traditional (SRR = 0.46, 95% CI 0.33-0.64) and modernizing groups (SRR = 0.70, 95% CI 0.59-0.84). This crossover between the sex es with advancing age is also evident for BP levels in a larger sample of societies and suggests a biological basis for hypertension risk. ( C) 1995 Wiley-Liss, Inc.