Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Reproductive Biology and Endocrinology
Published in: Reproductive Biology and Endocrinology 1/2020

01-12-2020 | Polycystic Ovary Syndrome | Review

Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression

Authors: Mina Amiri, Fahimeh Ramezani Tehrani, Samira Behboudi-Gandevani, Razieh Bidhendi-Yarandi, Enrico Carmina

Published in: Reproductive Biology and Endocrinology | Issue 1/2020

Login to get access

Abstract

Background

A limited number of publications have assessed the prevalence of hypertension (HTN) in polycystic ovary syndrome (PCOS) patients with inconclusive results. Since in general populations the occurrence of hypertension is related to age per se, we investigated the prevalence (P) / relative risk (RR) of HTN in pooled patients with PCOS, vs control population among reproductive age women with PCOS, compared to menopause/aging patients.

Methods

PubMed, Scopus, ScienceDirect, web of science, and Google scholar were systematically searched for retrieving observational studies published from inception to April 2019 investigating the HTN in patients with PCOS. The primary outcome of interest was pooled P and RR of HTN in reproductive and menopausal/aging women with PCOS compared to control population.

Results

The pooled prevalence of HTN in reproductive and menopausal/aging women with PCOS was higher than in the control population [(Pooled P: 0.15, 95% CI: 0.12–0.18 vs. Pooled P: 0.09, 95% CI: 0.08–0.10) and (Pooled P: 0.49, 95% CI: 0.28–0.70 vs. Pooled P: 0.40, 95% CI: 0.22–0.57), respectively]. Compared to the control population, pooled relative risk (RR) of HTN patients was increased only in reproductive age PCOS (1.70-fold, 95% CI: 1.43–2.07) but not in menopausal/aging patients who had PCOS during their reproductive years. The same results were obtained for subgroups of population-based studies. Meta-regression analysis of population-based studies showed that the RR of HTN in reproductive age PCOS patients was 1.76-fold than menopausal/aging PCOS patients (P = 0.262).

Conclusion

This meta-analysis confirms a greater risk of HTN in PCOS patients but demonstrates that this risk is increased only in reproductive age women with PCOS, indicating that after menopause, having a history of PCOS may not be as an important predisposing factor for developing HTN.
Appendix
Available only for authorised users
Literature
1.
Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011;7(4):219.CrossRefPubMed
2.
Calderon-Margalit R, Siscovick D, Merkin SS, Wang E, Daviglus ML, Schreiner PJ, et al. Prospective Association of Polycystic Ovary Syndrome with coronary artery calcification and carotid-intima-media thickness significance: the coronary artery risk development in young adults Women’s study. Arterioscler Thromb Vasc Biol. 2014;34(12):2688–94.CrossRefPubMed
3.
Chang AY, Oshiro J, Ayers C, Auchus RJ. Influence of race/ethnicity on cardiovascular risk factors in polycystic ovary syndrome, the Dallas heart study. Clin Endocrinol (Oxf). 2016;85(1):92–9.CrossRef
4.
Dahlgren E, Janson P, Johansson S, Lapidus L, Oden A. Polycystic ovary syndrome and risk for myocardial infarction: evaluated from a risk factor model based on a prospective population study of women. Acta Obstet Gynecol Scand. 1992;71(8):599–604.CrossRefPubMed
5.
Gateva A, Kamenov Z. Cardiovascular risk factors in Bulgarian patients with polycystic ovary syndrome and/or obesity. Obstet Gynecol Int. 2012;2012:306347.CrossRefPubMedPubMedCentral
6.
Hillman JK, Johnson LN, Limaye M, Feldman RA, Sammel M, Dokras A. Black women with polycystic ovary syndrome (PCOS) have increased risk for metabolic syndrome and cardiovascular disease compared with white women with PCOS. Fertil Steril. 2014;101(2):530–5.CrossRefPubMed
7.
Ding D-C, Tsai I-J, Wang J-H, Lin S-Z, Sung F-C. Coronary artery disease risk in young women with polycystic ovary syndrome. Oncotarget. 2018;9(9):8756.CrossRefPubMedPubMedCentral
8.
Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metabol. 1999;84(6):1897–9.CrossRef
9.
Daan NM, Louwers YV, Koster MP, Eijkemans MJ, de Rijke YB, Lentjes EW, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102(5):1444–51 e1443.CrossRefPubMed
10.
Shroff R, Kerchner A, Maifeld M, Van Beek EJ, Jagasia D, Dokras A. Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis. J Clin Endocrinol Metabol. 2007;92(12):4609–14.CrossRef
11.
Christian RC, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy PF, Fitzpatrick LA. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metabol. 2003;88(6):2562–8.CrossRef
12.
Tarkun I, Arslan BC, Canturk Z, Turemen E, Şahı̇n T, Duman C. Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J Clin Endocrinol Metabol. 2004;89(11):5592–6.CrossRef
13.
Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol. 1998;51(5):415–22.CrossRefPubMed
14.
Cibula D, Cifkova R, Fanta M, Poledne R, Zivny J, Skibova J. Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. Hum Reprod. 2000;15(4):785–9.CrossRefPubMed
15.
Joham AE, Boyle JA, Zoungas S, Teede HJ. Hypertension in reproductive-aged women with polycystic ovary syndrome and association with obesity. Am J Hypertens. 2014;28(7):847–51.CrossRefPubMed
16.
Holte J, Gennarelli G, Berne C, Bergh T, Lithell H. Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state? Hum Reprod. 1996;11(1):23–8.CrossRefPubMed
17.
Zimmermann S, Phillips RA, Dunaif A, Finegood DT, Wilkenfeld C, Ardeljan M, et al. Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance. J Clin Endocrinol Metabol. 1992;75(2):508–13.
18.
Meyer C, McGrath B, Teede H. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metabol. 2005;90(10):5711–6.CrossRef
19.
Merz CNB, Shaw LJ, Azziz R, Stanczyk FZ, Sopko G, Braunstein GD, et al. Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome. J Womens Health. 2016;25(9):875–81.CrossRef
20.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
21.
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions, vol. 4. New York: Wiley; 2011.
22.
Carmina E. Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines. Minerva Ginecol. 2004;56(1):1–6.PubMed
23.
Azziz R. Diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metabol. 2006;91(3):781–5.CrossRef
24.
Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metabol. 2006;91(11):4237–45.CrossRef
25.
Kandil M, Selim M. Hormonal and sonographic assessment of ovarian reserve before and after laparoscopic ovarian drilling in polycystic ovary syndrome. BJOG. 2005;112(10):1427–30.CrossRefPubMed
26.
Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270.CrossRefPubMed
27.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
28.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343:d5928.CrossRefPubMedPubMedCentral
29.
Chobanian AV. National heart, lung, and blood institute joint national committee on prevention, detection, evaluation, and treatment of high blood pressure; national high blood pressure education program coordinating committee: the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama. 2003;289:2560–72.CrossRefPubMed
30.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMed
31.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.CrossRefPubMed
32.
Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Publ Health. 2014;72(1):39.CrossRef
33.
L'ABBÉ KA, Detsky AS, O'rourke K. Meta-analysis in clinical research. Ann Intern Med. 1987;107(2):224–33.CrossRefPubMed
34.
Chan WPA, Ngo DT, Sverdlov AL, Rajendran S, Stafford I, Heresztyn T, et al. Premature aging of cardiovascular/platelet function in polycystic ovarian syndrome. Am J Med. 2013;126(7):640 e641–640. e647.CrossRefPubMed
35.
Chang AY, Ayers C, Minhajuddin A, Jain T, Nurenberg P, De Lemos JA, et al. Polycystic ovarian syndrome and subclinical atherosclerosis among women of reproductive age in the Dallas heart study. Clin Endocrinol (Oxf). 2011;74(1):89–96.CrossRef
36.
Glintborg D, Rubin KH, Nybo M, Abrahamsen B, Andersen M. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome. Eur J Endocrinol. 2015;172(5):627–38.CrossRefPubMed
37.
Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metabol. 2015;100(3):911–9.CrossRef
38.
Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metabol. 2006;91(4):1357–63.CrossRef
39.
Meun C, Franco OH, Dhana K, Jaspers L, Muka T, Louwers Y, et al. High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the Rotterdam study. J Clin Endocrinol Metabol. 2018;103(4):1622–30.CrossRef
40.
Okoroh EM, Boulet SL, George MG, Hooper WC. Assessing the intersection of cardiovascular disease, venous thromboembolism, and polycystic ovary syndrome. Thromb Res. 2015;136(6):1165–8.CrossRefPubMedPubMedCentral
41.
Sirmans SM, Parish RC, Blake S, Wang X. Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population. J Invest Med. 2014;62(6):868–74.CrossRef
42.
Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf). 2000;52(5):595–600.CrossRef
43.
Bird ST, Hartzema AG, Brophy JM, Etminan M, Delaney JA. Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis. Can Med Assoc J. 2013;185(2):E115–20.CrossRef
44.
Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013;28(9):2562–9.CrossRefPubMed
45.
Tehrani FR, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, et al. Trend of cardio-metabolic risk factors in polycystic ovary syndrome: a population-based prospective cohort study. PLoS One. 2015;10(9):e0137609.CrossRef
46.
Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011;9:39.
47.
Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in southwest of Iran. Reprod Biol Endocrinol. 2014;12:89.
48.
Behboudi-Gandevani S, Tehrani FR, Hosseinpanah F, Khalili D, Cheraghi L, Kazemijaliseh H, et al. Cardiometabolic risks in polycystic ovary syndrome: long-term population-based follow-up study. Fertil Steril. 2018;110(7):1377–86.CrossRefPubMed
49.
Haakova L, Cibula D, Rezabek K, Hill M, Fanta M, Zivny J. Pregnancy outcome in women with PCOS and in controls matched by age and weight. Hum Reprod. 2003;18(7):1438–41.CrossRefPubMed
50.
Iftikhar S, Collazo-Clavell M, Roger VL, Sauver JS, Brown R Jr, Cha S, et al. Risk of cardiovascular events in patients with polycystic ovary syndrome. Neth J Med. 2012;70(2):74.PubMedPubMedCentral
51.
Lunde O, Tanbo T. Polycystic ovary syndrome: a follow-up study on diabetes mellitus, cardiovascular disease and malignancy 15–25 years after ovarian wedge resection. Gynecol Endocrinol. 2007;23(12):704–9.CrossRefPubMed
52.
Schmidt J, Landin-Wilhelmsen K, Brännström M, Dahlgren E. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metabol. 2011;96(12):3794–803.CrossRef
53.
Shi Y, Cui Y, Sun X, Ma G, Ma Z, Gao Q, et al. Hypertension in women with polycystic ovary syndrome: prevalence and associated cardiovascular risk factors. Eur J Obstet Gynecol Reprod Biol. 2014;173:66–70.CrossRefPubMed
54.
Vrbikova J, Cifkova R, Jirkovska A, Lanska V, Platilova H, Zamrazil V, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod. 2003;18(5):980–4.CrossRefPubMed
55.
Luque-Ramírez M, Mendieta-Azcona C, Alvarez-Blasco F, Escobar-Morreale HF. Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome. Hum Reprod. 2007;22(12):3197–203.CrossRefPubMed
56.
Marchesan LB, Spritzer PM. ACC/AHA 2017 definition of high blood pressure: implications for women with polycystic ovary syndrome. Fertil Steril. 2019;111(3):579–87 e571.CrossRefPubMed
57.
Wild SH. Mortality and morbidity from coronary heart disease, diabetes and hypertension in women with polycystic ovary syndrome at long-term follow-up. London: School of Hygiene and Tropical Medicine (University of London); 2000.
58.
Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, Azizi F. Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study. PLoS One. 2015;10(9):e0137609.CrossRefPubMedPubMedCentral
59.
Jaliseh HK, Tehrani FR, Behboudi-Gandevani S, Hosseinpanah F, Khalili D, Cheraghi L, et al. Polycystic ovary syndrome is a risk factor for diabetes and prediabetes in middle-aged but not elderly women: a long-term population-based follow-up study. Fertil Steril. 2017;108(6):1078–84.CrossRef
60.
Christakou CD, Diamanti-Kandarakis E. Role of androgen excess on metabolic aberrations and cardiovascular risk in women with polycystic ovary syndrome. Womens Health. 2008;4(6):583–94.
61.
Azziz R. Does the risk of diabetes and heart disease in women with polycystic ovary syndrome lessen with age? Elsevier; 2017.
62.
Ramezani Tehrani F, Amiri M, Behboudi-Gandevani S, Bidhendi-Yarandi R, Carmina E. Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis. Gynecol Endocrinol. 2020;36(1):12–23.
63.
Carmina E. Cardiovascular risk and events in polycystic ovary syndrome. Climacteric. 2009;12(sup1):22–5.CrossRefPubMed
64.
Carmina E, Campagna A, Lobo R. Emergence of ovulatory cycles with aging in women with polycystic ovary syndrome (PCOS) alters the trajectory of cardiovascular and metabolic risk factors. Hum Reprod. 2013;28(8):2245–52.CrossRefPubMed
Metadata
Title
Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression
Authors
Mina Amiri
Fahimeh Ramezani Tehrani
Samira Behboudi-Gandevani
Razieh Bidhendi-Yarandi
Enrico Carmina
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2020
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-020-00576-1

Other articles of this Issue 1/2020

Reproductive Biology and Endocrinology 1/2020 Go to the issue

Research

Successful pregnancy after prenatal diagnosis by NGS for a carrier of complex chromosome rearrangements

Review

Review of psychological stress on oocyte and early embryonic development in female mice

Review

Organoid technology in female reproductive biomedicine

Research

Increased risk of maternal and neonatal complications in hormone replacement therapy cycles in frozen embryo transfer

Research

Characterization of VDR and CYP27B1 expression in the endometrium during the menstrual cycle before embryo transfer: implications for endometrial receptivity

Research

Tripeptidyl peptidase I promotes human endometrial epithelial cell adhesive capacity implying a role in receptivity