To the Editor The updated 2014 guidelines for the management of high BP in adults by the panel appointed to the JNC 8¹ did not consider issues relevant to sex differences in hypertensive health. Variables of age and race were addressed, but stratification by sex was omitted. Sex is a determinant of health outcomes, with differences in metabolism, hormonal milieu, pharmacodynamics, pathophysiology, and therapeutic considerations.

The issue of therapeutic options stratified by sex is of clear importance. Although some controversy remains regarding fetal teratogenicity of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), given the degree of irreversible risk, this needs to be a consideration when choosing pharmacological options for women at risk of becoming pregnant. According to the European Consensus Guidelines for the management of hypertension, 鈥淚n women with child-bearing potential, ACE inhibitors and angiotensin receptor blockers should be avoided, due to possible teratogenic effects.鈥�²