Hypertension in Polycystic Ovary Syndrome: Novel Insights

Author(s): Djuro Macut*, Violeta Mladenović, Jelica Bjekić-Macut, Sarantis Livadas, Olivera Stanojlović, Dragan Hrnčić, Aleksandra Rašić-Marković, Danijela Vojnović Milutinović, Zoran Andrić.

Journal Name: Current Hypertension Reviews

Volume 16 , Issue 1 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Polycystic ovary syndrome (PCOS) is a common endocrine disease in women during reproductive age. It was shown that PCOS women are with high risk for dyslipidemia, glucose intolerance, type 2 diabetes and metabolic syndrome. These factors are considered to represent traditional risk factors for the occurrence of cardiovascular disease. Observed increased risk for hypertension in PCOS women seems to be associated with insulin resistance and hyperinsulinemia. Both conditions interfere with the endothelium-dependent vasodilatation mechanisms causing vascular muscle wall hypertrophy. Obesity and insulin resistance are considered key factors for the alteration of blood pressure in PCOS women. Higher cardiovascular risk is implicated in PCOS with aging and its consequent association with both systolic and diastolic blood pressure. The elements of renin-angiotensin-aldosterone system (RAAS) have an impact on endothelial dysfunction as a marker of cardiovascular damage that could be modified is women with PCOS. Androgens and components of RAAS are involved in the process of atherogenesis in PCOS women. Therefore, it is hypothesized that spironolactone treatment could ameliorate endothelial dysfunction in PCOS women. Recently it was shown that telmisartan, angiotensin II receptor antagonist poses insulinsensitizing capacity to activate PPAR gamma and mediate favorable metabolic and reproductive effects in hypertensive PCOS women.

Keywords: Polycystic ovary syndrome, hypertension, obesity, insulin resistance, RAAS, hyperinsulinemia.

[1]
Wanderley MDS, Pereira LCR, Santos CB, Cunha VSD, Neves MVJ. Association between insulin resistance and cardiovascular risk factors in polycystic ovary syndrome patients. Rev Bras Ginecol Obstet 2018; 40(4): 188-95.
[2]
Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med 2014; 2(6): 56.
[3]
Macut D, Bačević M, Božić-Antić I, et al. Predictors of subclinical cardiovascular disease in women with polycystic ovary syndrome: Interrelationship of dyslipidemia and arterial blood pressure. Int J Endocrinol 2015; 2015 :812610
[4]
Daan NM, Louwers YV, Koster MP, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: Who is really at risk? Fertil Steril 2014; 102(5): 1444-51.e3.
[5]
Behboodi Moghadam Z, Fereidooni B, Saffari M, Montazeri A. Measures of health-related quality of life in PCOS women: A systematic review. Int J Womens Health 2018; 10: 397-408.
[6]
Conway G, Dewailly D, Diamanti-Kandarakis E, et al. ESE PCOS Special Interest Group. The polycystic ovary syndrome: A position statement from the European Society of Endocrinology. Eur J Endocrinol 2014; 171(4): 1-29.
[7]
Karbek B, Ozbek M, Karakose M, et al. Copeptin, a surrogate marker for arginine vasopressin, is associated with cardiovascular risk in patients with polycystic ovary syndrome. J Ovarian Res 2014; 7: 31.
[8]
Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8: 41.
[9]
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81(1): 19-25.
[10]
Lønnebotn M, Natvig GK, Benediktsdóttir B, et al. Polycystic ovary syndrome, body mass index and hypertensive disorders in pregnancy. Pregnancy Hypertens 2018; 11: 32-7.
[11]
Zhang B, Wang J, Shen S, et al. Association of androgen excess with glucose intolerance in women with polycystic ovary syndrome. Biomed Res Int 2018; 2018:6869705
[12]
Giallauria F, Orio F, Palomba S, Lombardi G, Colao A, Vigorito C. Cardiovascular risk in women with polycystic ovary syndrome. J Cardiovasc Med (Hagerstown) 2008; 9(10): 987-92.
[13]
Merz CN, Shaw LJ, Azziz R, et al. Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome. J Womens Health (Larchmt) 2016; 25(9): 875-81.
[14]
Victor VM, Rocha M, Banuls C, et al. Induction of oxidative stress and human leukocyte/endothelial cell interactions in polycystic ovary syndrome patients with insulin resistance. J Clin Endocrinol Metab 2011; 96(10): 3115-22.
[15]
Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists (AACE). American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). Disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - PART 1. Endocr Pract 2015; 21(11): 1291-300.
[16]
Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists (AACE). American College of Endocrinology (ACE); Androgen Excess and PCOS Society. Disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - Part 2. Endocr Pract 2015; 21(12): 1415-26.
[17]
Amato MC, Verghi M, Galluzzo A, Giordano C. The oligomenorrhoic phenotypes of polycystic ovary syndrome are characterized by a high visceral adiposity index: A likely condition of cardiometabolic risk. Hum Reprod 2011; 26(6): 1486-94.
[18]
Repaci A, Gambineri A, Pasquali R. The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol 2011; 335(1): 30-41.
[19]
Macut D, Simic T, Lissounov A, et al. Insulin resistance in non-obese women with polycystic ovary syndrome: Relation to byproducts of oxidative stress. Exp Clin Endocrinol Diabetes 2011; 119(7): 451-5.
[20]
Kravariti M, Naka KK, Kalantaridou SN, et al. Predictors of endothelial dysfunction in young womenwith polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(9): 5088-95.
[21]
Hallajzadeh J, Khoramdad M, Karamzad N, et al. Metabolic syndrome and its components among women with polycystic ovary syndrome: A systematic review and meta-analysis. J Cardiovasc Thorac Res 2018; 10(2): 56-69.
[22]
Joham AE, Boyle JA, Zoungas S, Teede HJ. Hypertension in reproductive-aged women with polycystic ovary syndrome and association with obesity. Am J Hypertens 2015; 28(7): 847-51.
[23]
Zhou Y, Wang X, Jiang Y, et al. Association between polycystic ovary syndrome and the risk of stroke and all-cause mortality: Insights from a meta-analysis. Gynecol Endocrinol 2017; 33(12): 904-10.
[24]
Glintborg D, Rubin KH, Nybo M, Abrahamsen B, Andersen M. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol 2018; 17(1): 37.
[25]
Rubin KH, Glintborg D, Nybo M, Abrahamsen B, Andersen M. Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102(10): 3848-57.
[26]
Glintborg D. Endocrine and metabolic characteristics in polycystic ovary syndrome. Dan Med J 2016; 63(4) : pii: B5232
[27]
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. CMAJ 2013; 185(2): E115-20.
[28]
Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016; 22(6): 687-708.
[29]
Tzeng CR, Chang YC, Chang YC, Wang CW, Chen CH, Hsu MI. Cluster analysis of cardiovascular and metabolic risk factors in women of reproductive age. Fertil Steril 2014; 101(5): 1404-10.
[30]
Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004; 364(9438): 937-52.
[31]
Martins Wde P, Soares GM, Vieira CS, dos Reis RM, de Sá MF, Ferriani RA. Cardiovascular risk markers in polycystic ovary syndrome in women with and without insulin resistance. Rev Bras Ginecol Obstet 2009; 31(3): 111-6.
[32]
Hudecova M, Holte J, Olovsson M, Larsson A, Berne C, Sundstrom-Poromaa I. Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: Long-term follow-up. Fertil Steril 2011; 96(5): 1271-4.
[33]
Oh JY, Lee JA, Lee H, Oh JY, Sung YA, Chung H. Serum C-reactive protein levels in normal-weight polycystic ovary syndrome. Korean J Intern Med 2009; 24(4): 350-5.
[34]
Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health 2015; 7: 745-63.
[35]
Elting MW, Korsen TJ, Bezemer PD, Schoemaker J. Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod 2001; 16(3): 556-60.
[36]
Yanes Cardozo LL, Romero DG, Reckelhoff JF. cardiometabolic features of polycystic ovary syndrome: Role of androgens. Physiology (Bethesda) 2017; 32(5): 357-66.
[37]
Bentley-Lewis R, Seely E, Dunaif A. Ovarian hypertension: Polycystic ovary syndrome. Endocrinol Metab Clin North Am 2011; 40(2): 433-49.
[38]
Welt CK, Carmina E. Lifecycle of polycystic ovary syndrome (PCOS): From in utero to menopause. J Clin Endocrinol Metab 2013; 98(12): 4629-38.
[39]
Repaci A, Gambineri A, Pasquali R. The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol 2011; 335(1): 30-41.
[40]
Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97(1): 28-38.e25.
[41]
Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the Polycystic Ovary Syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95(5): 2038-49.
[42]
Diamanti-Kandarakis E, Christakou CD, Kandaraki E, Economou FN. Metformin: An old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol 2010; 162(2): 193-212.
[43]
Wang YW, He SJ, Feng X, et al. Metformin: A review of its potential indications. Drug Des Devel Ther 2017; 11: 2421-9.
[44]
Harrison CL, Lombard CB, Moran LJ, Teede HJ. Exercise therapy in polycystic ovary syndrome: A systematic review. Hum Reprod Update 2011; 17(2): 171-83.
[45]
Inzucchi SE, Bergenstal RM, Buse JB, et al. American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012; 35(6): 1364-79.
[46]
Naderpoor N, Shorakae S, de Courten B, Misso ML, Moran LJ, Teede HJ. Metformin and lifestyle modification in polycystic ovary syndrome: Systematic review and meta-analysis. Hum Reprod Update 2016; 22(3): 408-9.
[47]
Legro RS, Arslanian SA, Ehrmann DA, et al. Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98(12): 4565-92.
[48]
Bajuk Studen K, Jensterle Sever M, Pfeifer M. Cardiovascular risk and subclinical cardiovascular disease in polycystic ovary syndrome. Front Horm Res 2013; 40: 64-82.
[49]
Studen KB, Sebestjen M, Pfeifer M, Prezelj J. Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome. Eur J Endocrinol 2011; 164(3): 389-95.
[50]
Jensterle M, Janez A, Vrtovec B, et al. Decreased androgen levels and improved menstrual pattern after angiotensin II receptor antagonist telmisartan treatment in four hypertensive patients with polycystic ovary syndrome: Case series. Croat Med J 2007; 48(6): 864-70.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 1
Year: 2020
Page: [55 - 60]
Pages: 6
DOI: 10.2174/1573402115666190531071422

Article Metrics

PDF: 25
HTML: 4