Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state?

The aim of this study was to evaluate office and 24 h blood pressures in women with polycystic ovary syndrome (PCOS) and normal controls in relation to insulin sensitivity. Office blood pressure, insulin sensitivity (euglycaemic hyperinsulinaemic clamp) and body fat distribution (skin-folds, waits:hip ratio) were investigated in 36 women with PCOS and 55 controls [body mass index (BMI) for PCOS patients, mean (confidence interval) 26.3 (24.6-28.2); controls, 25.1 (24.0-26.9)], and ambulatory 24 h blood pressure was recorded in representative subgroups of 17 and 16 women respectively. Compared with the controls, the women with PCOS had higher day-time systolic (mean +/- SD, 126 +/- 11 versus 119 +/- 12 mm Hg, P < 0.05) and mean arterial blood pressures (92 +/- 7 versus 86 +/- 7 mm Hg, P < 0.05) in ambulatory recordings, and greater increases in pulse rate (70%; P < 0.05) from night to day-time recordings, whereas the groups did not differ significantly in day-time diastolic blood pressure (74 +/- 6 versus 70 +/- 6 mm Hg, P = 0.05) or in night-time recordings. The women with PCOS had a more pronounced truncal-abdominal fat distribution (P < 0.05) and a lower insulin-mediated glucose disposal (P < 0.01) during the clamp. The increased day-time blood pressures in women with PCOS persisted after adjusting for BMI, body fat distribution and insulin resistance. It is concluded that women with PCOS have an increased prevalence of labile blood pressure, which may indicate a pre-hypertensive state, adding a further risk factor for cardiovascular disease in these women.