Risk factors and prediction model for hypertension in women with hyperandrogenic phenotypes of polycystic ovary syndrome

Background Women with polycystic ovary syndrome(PCOS) are more likely to develop hypertension from early adulthood, more often with hyperandrogenic phenotypes of PCOS. We aimed to identify the risk factors for hypertension in all three forms of hyperandrogenic PCOS phenotypes and tried to establish a prediction model to evaluate the risk. Methods 906 patients with all three forms of hyperandrogenic PCOS phenotypes, according to modified Rotterdam diagnostic criteria, were divided into two groups: hypertensive group, n = 361 and normotensive group, n = 545. Assessment of endocrine hormones were part of routine follow-up of patients. The body mass index (BMI) was calculated and laboratory evaluation included glycemia, uric acid, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C). Low-density lipoprotein cholesterol (LDL-C) was calculate. Insulin resistance was assessed with the use of the homeostasis model assessment (HOMA1-IR). Metabolic syndrome was defined (MetS; ATP III criteria): waist >88 cm, fasting glucose >5.6 mmol/L, hypertension, BP>130/85 mmHg, HDL<1.3 mmol/L, TG>1.7 mmol/L. Results Hypertensive patients were older (35.9±6.8 vs 34.8±6.0;p=0,004), more obese (28.5±4.4 vs 27.8±3.5;p=0.005), with significantly higher values of uric acid (342.2±91.7 vs 317.3±90.6;p=0,00006), HOMA1-IR(2.37±0.88 vs 2.20±0.70;p=0,002), total cholesterol (5.2±1.12 vs 5.0±1.14,;p=0,006), LDL-C (3.7±1.13 vs 3.5±1.25,;p=0,002), and lower HDL-C (1.11±0.28 vs 1,16±0.43;p=0,046). Patients in hypertensive group more often suffered from MetS (158 (43.8%) vs 190 (34.9%); p=0.004). Hypertension in PCOS associated with older age (0.960(0.937-0.984); p=0,001), higher values of uric acid(0.997(0.996-0.999); p=0,0001), insulin resistance (0.720(0.586-0.841); p=0,0001), and metabolic syndrome(1.388(1.049-1.836); p=0,022). In women 35 years of age or older the prevalence of hypertension was significantly higher (290 (80.3%) vs 71(19.7%);p=0.05). Conclusion This analysis indicated that metabolic dysfunction, higher uric acid, obesity/overweight and age significantly associated with hypertension in hyperandrogenic PCOS. Risk stratification for hypertension in PCOS may aid efforts in early identification of the disorder. Treatment of the risk factors inherent to PCOS, such as insulin resistance, obesity/overweight, metabolic disorders, may minimize the risk not only for the development of hypertension but also for incident cardiovascular disease independent of hypertension.