The concentrations of triglycerides and cholesterol found in high-density lipoproteins were comparable in patients of different sexes and were within the normal range. The content of low-density lipoprotein cholesterol in the blood was comparable to the normal level in patients of both sexes.

Blood glucose and creatinine concentrations in all patients with stage 2 AH were within the normal range and did not differ in different sexes. The levels of thromboxane and prostacyclin metabolites in all examined patients were beyond the normative values. In women, violations of their levels tended to be more pronounced, forming a tendency to a more pronounced imbalance in their blood of arachidonic acid metabolites.

The glomerular filtration rate in patients with stage 2 AH showed significant gender differences. In sick men, this indicator was slightly below the norm, while in women it was significantly reduced, yielding to the level of men by 25.0%. The thickness in the vessels of the intima and media in women with stage 2 AH exceeded the normative level and prevailed over the value of this indicator in men by 23.0%.

Various aspects of AH have been studied for a long time (Mehta et al., 2016). This is carried out both in the clinic and in the course of various experiments (Kotova et al., 2017; Karpov et al., 2021b). The main invariable risk factors for the development of hypertension are known - gender and age (Zavalishina et al., 2018). At the same time, most researchers note that the incidence of hypertension increases with increasing age (Mendelsohn & Karas, 2005). At the same time, the study of gender characteristics in the development and course of AH was started not so long ago. For the first time in the Framingham Heart Study, it was possible to find clear differences between hypertensive patients of different sexes. It is noticed that up to 50 years of age AH ​​affects men more often. At an older age, the incidence of this disease increases in women, which is associated with an increase in the number of factors contributing to the development of hypertension in them (Liu et al., 2001; Stramba-Badiale et al., 2006).

The authors of this work found that in hypertensive patients with stage 1 AH in men, by the age of 49 years, higher numbers of systolic and diastolic blood pressure began to be noted compared to women. Their mean age of manifestation of hypertension was 51 years. The average age of registration for stage 2 AH in women was about 55 years. In hypertensive men, this age was 50 years. At the same time, in AH of the second stage, the blood pressure figures were higher in the female part of the observation group.

Being overweight and especially obese are strongly associated with an increased risk of numerous pathological conditions, including dyslipidemia, type 2 diabetes mellitus, metabolic syndrome, and focal segmental glomerulosclerosis (Aleksandrovna & Zavalishina, 2017). The authors noted that in patients with the first stage of AH in both sexes, there was a tendency to increase the body mass index. In women with the second stage of AH, the body mass index reached 30, while in men this indicator remained practically unchanged. The data obtained can be explained by hormonal changes in the body of a woman, which can increase the amount of body weight, leading to the appearance of abdominal obesity (Gallego et al., 2015; Karvonen-Gutierrez & Kim, 2016).

Metabolic risk factors for the occurrence of cardiovascular and metabolic disorders are recorded much more often in hypertension than in normatonic patients. Researchers have recently placed particular emphasis on waist circumference and waist-to-hip ratio, with less emphasis on body mass index. These indicators can more accurately indicate the appearance of abdominal obesity (Zavalishina, 2020). The authors found that in the case of the first stage of AH in both sexes, the waist volume remained within the normal range. However, in the course of the observation, it was noted that the ratio of the waist to the volume of the hips turned out to be greater in men, going beyond the normal range. In women with stage 2 AH, the waist volume and the ratio of waist to the hip volume were more than normal. In males, the average values ​​of waist volume were not greater than the threshold values. The value of the ratio of the volume of the waist to the volume of the hips did not exceed the normative level but was less than this value in women. The information obtained does not contradict the available information that with an increase in blood pressure, the ratio of waist volume to hip volume increases (Minges et al., 2017).

Earlier work revealed that there is an undoubted connection between the increase in the concentration of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and the risk of atherosclerosis manifestation. For the blood level of high-density lipoprotein cholesterol, this relationship is negative (Williams et al., 2018). The authors were able to show the comparability of total cholesterol levels in patients of both sexes with the first and second stages of AH. At the same time, all found concentrations of total cholesterol were above the normative level. Triglyceride concentrations showed a different pattern. Their average levels in patients of both sexes with the first and second stages of AH were within the generally accepted norm

When analyzing data on the level of low-density lipoprotein cholesterol, in the group with AH of the first stage, women showed a significantly higher content than men. In the second stage of AH, no differences in atherogenic low-density lipoprotein cholesterol were found between the sexes. The modern concept of the mechanism of atherosclerotic plaque formation in accordance with the lipid-infiltration theory assumes the entry into the subendothelial space of native and oxidized molecules, low-density lipoproteins. Moreover, the higher their level in the blood, the more intensively this process always proceeds (Zavalishina et al., 2021a). Consequently, women are highly susceptible to the rapid progression of atherosclerosis in the formation of hypertension.

In the work carried out in patients with the first stage of AH, a comparable concentration of high-density lipoprotein cholesterol in men and women was determined. In the group observed with hypertension in the second stage, no significant differences were also obtained. The level in patients with the second stage of AH was lower than in the first stage but did not decrease to the threshold level for high-density lipoprotein cholesterol.    

In terms of glucose, the reliability of gender differences was not obtained in patients with the first stage of AH and patients with the second stage of AH. This indicates the maintenance of carbohydrate metabolism at a normal level in all examined patients.

When assessing the glomerular filtration rate, it was possible to obtain the reliability of the differences in this indicator between the sexes in both comparison groups. Mean values ​​in men were significantly higher in the first stage of AH and in the second stage of AH. This allows us to say that women with hypertension are prone to earlier development of chronic kidney disease. It is known that estrogen has an antiproliferative effect on smooth muscle cells, and progesterone lowers the tone of arterioles and reduces sodium resorption in the renal tubules, thereby exerting an anti-mineralocorticoid effect. The loss of the optimal level of these hormones in postmenopausal women inevitably leads to the deterioration of renal function (Hodis et al., 2003; Zavalishina et al., 2021b).

At the same time, more pronounced disturbances in the synthesis of biologically important substances that can stimulate the aggregation of blood cells were noted in women with hypertension in platelets and vessel walls. In women with AH, the level of blood proaggregants pronouncedly increased as the disease progressed compared to the men. The greater intensification of thromboxane synthesis that develops in women, combined with a greater weakening of the formation of a substance with the opposite effect - prostacyclin, creates a more pronounced imbalance in the plasma between the activity of antiplatelet agents and substances - proaggregants. It can be thought that the violation of the ratio of arachidonate derivatives, which is created in AH, creates more pronounced conditions for microrheological disorders in women, starting from stage 1 of AH.

According to the definition of the World Health Organization, atherosclerosis is called "a variable combination of changes in the intima of the arteries, including the accumulation of lipids, lipoproteins, complex carbohydrates, fibrous tissue, blood components, calcification in the middle membrane of the vascular wall." It is recognized that in the walls of the arteries in patients with hypertension under the influence of pressure loading, there is a gradual increase in the thickness of the intima and media of the vessels, associated with the progression of atherosclerosis (Finn et al., 2010). According to the known data on the presence of asymptomatic target organ lesions in AH, it is appropriate to speak about the presence of subclinical atherosclerosis in a patient with AH (thickness of the intima/media complex> 0.9 mm) (Zavalishina et al., 2021c).

The world medical science recognizes the presence of gender differences in the formation of atherosclerotic vascular lesions, caused, first of all, by the peculiarities of the influence of the existing endocrine profile on the body (Monleiro, 2005). Estrogens slow down the remodeling of large arteries and inhibit the accumulation of foam cells in the vascular wall. They are also able to reduce the stiffness of the arterial wall and the magnitude of arterial systolic pressure by relaxing smooth myocytes in the walls of blood vessels. Progesterone also lowers the tone of arterioles and inhibits the proliferation of smooth muscle coronary arteries due to the blockade of slow calcium channels in their walls (Bots et al., 1994; Bonithon-Kopp et al., 1996).

In the study, men with the first stage of AH showed significantly lower values ​​of the part of the intima-media of the vessels compared with women with stage 1 AH. In the group with AH of the second stage, men again demonstrated a significantly lower value of the intima-media complex index than women. The data obtained are consistent with previously published works, where in premenopausal patients a positive relationship was found between an increase in the thickness of the intima-media complex of the carotid common artery and an increase in the level of pulse pressure, triglyceride levels, body mass index, and age (Fröhlich et al., 2004; Zavalishina, 2021d). Thus, according to the information found in our study, it can be assumed that the examined men do not have, and the women taken under observation have subclinical atherosclerosis.

Considering the state of metabolic parameters in patients with hypertension, one can think that they had excessive body mass indices, indicating the presence of obesity in combination with lipid metabolism disorders to the level of atherogenic dyslipidemia (Lobo, 2017; Zavalishina et al., 2021e). Changes in metabolism are already present at the onset of arterial hypertension in women. This is consistent with the point of view of a decrease in the severity of the cardioprotective effect of estrogens during premenopause (Mikhaylova et al., 2021; Zavalishina et al., 2022).

Conclusion

Arterial hypertension is a very common disease globally. The prevalence of hypertension increases with age. Its presence always aggravates the work of the cardiovascular system, accelerating the development of atherosclerosis. Worldwide, hypertension is an important factor in disability, disability, and death in patients of both sexes. Taking into account sex differences makes it possible to reveal the gender characteristics of the values ​​of pathogenetically significant indicators in patients with arterial hypertension. There is reason to believe that from the very beginning of the development of AH in women, more pronounced and more rapidly progressive lipid, hemostatic, and renal disorders occur in comparison with men. This significantly worsens their prognosis and requires more attention from clinicians for women with hypertension.

Acknowledgments: The team of authors thanks the administration of the Moscow City Pedagogical University, Institute of Natural Sciences and Sports Technology for the opportunity to research its basis.

Conflict of interest: None

Financial support: None

Ethics statement: The research was approved by the Ethics Committee of Moscow City Pedagogical University, Institute of Natural Sciences and Sports Technologies (record №10 from 11.10.2017).