Introduction: Hypertension (HTN) disproportionately affects men and women differently in terms of cardiovascular risk and end-organ damage, yet sex-specific analyses remain scarce in sub-Saharan Africa. This study examines sex differences in the clinical profile, complications and treatment of HTN in a hospital-based cohort in Gabon.

Methods: A retrospective cross-sectional analysis was conducted on 807 hypertensive patients followed at the Centre Hospitalier Universitaire (CHU) de Libreville from January 2019 to January 2023. Data were stratified by sex. Categorical variables were compared using the Chi-square test; continuous non-normally distributed variables by the Mann-Whitney U test. Statistical significance was set at p < 0.05.

Results: Among 807 patients, 523 were women (64.8%) and 284 were men (35.2%). Women were slightly older (median 55 vs 53 years; p=0.024). HTN grade (p=0.694), type (p=0.881) and pulse pressure did not differ significantly between sexes, indicating equivalent blood pressure burden. However, men had significantly more target organ damage: renal failure (9.5% vs 3.8%; p=0.002), total stroke (12.7% vs 7.8%; p=0.034), total heart failure (7.4% vs 3.8%; p=0.034), and overall target organ damage (27.1% vs 13.6%; p < 0.001). Headaches were more frequent in women (16.3% vs 9.2%; p=0.007). Women were prescribed more thiazide diuretics (41.3% vs 32.7%; p=0.021) and central antihypertensives (7.8% vs 3.9%; p=0.041). Therapeutic rupture did not differ by sex (20.8% vs 21.1%; p=0.996). Pulse pressure was significantly higher in women aged ≥ 60 years (median 68 vs 64 mmHg; p=0.039).

Conclusion: Despite identical blood pressure severity, men with HTN in Libreville experience significantly more target organ damage than women, particularly renal failure and stroke. These findings highlight the need for sex-specific risk stratification and more intensive renal and cerebrovascular monitoring in male hypertensives in sub-Saharan Africa.