Reproductive age women with PCOS have a 1.7-3x increased risk of hypertension compared to individuals without the condition.[1],[2]  In this article we explore the link between PCOS and Hypertension.

Hypertension is high blood pressure defined as a reading of 130/80 millimeters of mercury (mm Hg) or higher (or 140/90 in Europe).[3],[4]  This standard measurement includes the systolic blood pressure (top number), when your heart beats, and diastolic blood pressure (bottom number), when your heart is relaxing.[5]  High blood pressure causes damage to the walls of the arteries over time and increases the risk of cardiovascular complications like a heart attack, aneurysm or stroke.[6]  High blood pressure can also increase the risk of metabolic syndrome, kidney problems, eye problems, changes to memory or thinking and dementia.[7]

PCOS is associated with elevated levels of androgens[8], sex hormones that are produced in the ovaries, start at puberty and play a key role in reproductive health.[9] 

• An Increase in the level of circulating androgens disrupts the way that adipose tissue, the body fat or connective tissue that extends throughout your body,[10] metabolizes glucose;[11]

• The adipose tissue produces less adiponectin, a hormone that helps with insulin sensitivity and inflammation,[12] and more leptin,[13] a hormone that causes you to feel hungry in efforts to maintain enough fat stores for long-term health;[14]

• Reduced adiponectin leads to insulin resistance, whereby the body doesn’t respond as it should to the effects of insulin;[15]

• Insulin resistance leads to elevated production of insulin in the pancreas as a compensatory measure, leading to elevated levels in insulin in the blood or hyperinsulinemia;[16] and

• Eventually, the pancreas is no longer able to produce enough insulin to maintain healthy levels of blood sugar and the individual develops hyperglycemia, or high blood sugar.

Androgen excess, insulin resistance, hyperinsulinemia and hyperglycemia contribute to hypertension through a number of mechanisms:[17],[18]

• Androgen excess may directly affect both the properties of the arterial walls and the process of plaque build up;[19]

• Insulin resistance stimulates the sympathetic nervous system, increasing glucose metabolism in the brain’s arcuate nucleus, leading to increased heart rate and narrowed blood vessels;[20]

• In individuals with insulin resistance, hyperinsulinemia may decrease the production of nitric oxide (the opposite of the effect in healthy individuals) resulting in constriction of blood vessels;[21] and

• Hyperinsulinemia and hyperglycemia promote reabsorption of sodium by the kidneys[22], leading to increased salt in the blood, increased fluid retention and increased blood pressure[23]; and

• Androgen excess and insulin resistance are believed to contribute to elevated aldosterone levels[24] (around 30% of individuals with PCOS have hyperaldosteronism)[25] resulting in salt and water retention and therefore increased blood pressure.[26]

Risk factors for primary hypertension (where there is no single cause) include:[27],[28]

• Family history of hypertension, cardiovascular disease or diabetes;

• Being over the age of 55;

• Having obesity;

• Having an unhealthy diet, particularly one high in sodium/salt;

• Experiencing high levels of stress;

• Having a sedentary lifestyle, lacking in exercise;

• High consumption of alcohol; and

• Being black (high blood pressure can develop at an earlier age in black people).

Risk factors for secondary hypertension (where there is at least one clear cause) include:[29],[30]

• Certain medications including cold medicines, oral contraceptives, immunosuppressants and some pain relievers;

• Use of recreational drugs such as amphetamines and cocaine;

• Congenital heart defects;

• Being pregnant;

• Obstructive sleep apnea;

• Thyroid problems;

• Primary aldosteronism (Conn’s syndrome), a rare disorder that causes the adrenal glands to produce too much aldosterone, a hormone that helps regulate blood pressure;[31]

• Tumors of the adrenal gland;

• Kidney disease;

• Renal vascular diseases such as renal artery stenosis that affect the blood flow in the arteries in your kidneys; and

• Use of tobacco products

High blood pressure is diagnosed via a simple non-invasive test with a blood pressure cuff.  In certain instances these readings may be inaccurate due to the specific setting of the test.  In white coat hypertension an individual may present with unusually elevated blood pressure at the doctors office whereas in masked hypertension an individual may have normal blood pressure during the test but increased blood pressure at other points during the day.[32]  A clinician may recommend further tests to investigate whether there is an underlying cause of the hypertension.[33]

In the first instance, your doctor may recommend lifestyle changes to manage high blood pressure.  If hypertension isn’t effectively managed with diet and exercise, there are a variety of medications that can be used to treat hypertension:[34]

• Diuretics to help remove sodium/salt and water from the body;

• Angiotensin-converting enzyme (ACE) inhibitors to relax blood vessels;

• Angiotensin II receptor blockers (ARBs) to relax blood vessels;

• Calcium channel blockers to relax the muscles of blood vessels and, in some cases, slow your heart rate;

• Alpha blockers to reduce constriction of blood vessels;

• Alpha-beta blockers to reduce constriction of blood vessels and slow your heart rate;

• Beta blockers (often in combination with other medications) to reduce heart rate and widen blood vessels;

• Aldosterone antagonists to block the action of aldosterone and reduce the retention of sodium/salt and water;

• Renin inhibitors to slow the production of renin in the kidneys which contributes to high blood pressure;

• Vasodilators to prevent the narrowing of blood vessels; and

• Central-acting agents to act on the brain to prevent increased heart rate and narrowing of blood vessels.

Reviewed by Riya Ganguly PhD., MBA, ICD.D, expert on technology transfer, new venture development and research facilitation

Sources

[1] https://ec.bioscientifica.com/view/journals/ec/10/2/EC-20-0527.xml

[2] https://rbej.biomedcentral.com/articles/10.1186/s12958-020-00576-1

[3] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[4] https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

[5] https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

[6] https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

[7] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[8] https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics/

[9] https://my.clevelandclinic.org/health/articles/22002-androgens

[10] https://my.clevelandclinic.org/health/body/24052-adipose-tissue-body-fat

[11] https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-022-01091-0

[12] https://my.clevelandclinic.org/health/articles/22439-adiponectin

[13] https://my.clevelandclinic.org/health/articles/22446-leptin

[14] https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-022-01091-0

[15] https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/hyperinsulinemia/faq-20058488

[16] https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

[17] https://www.rupahealth.com/post/polycystic-ovary-syndrome-pcos-and-its-association-with-hypertension

[18] https://pmc.ncbi.nlm.nih.gov/articles/PMC7391603/

[19] https://journals.sagepub.com/doi/full/10.2217/17455057.4.6.583

[20] https://pmc.ncbi.nlm.nih.gov/articles/PMC8156658/#

[21] https://www.ahajournals.org/doi/10.1161/01.CIR.93.7.1331#

[22] https://pmc.ncbi.nlm.nih.gov/articles/PMC3095959/#

[23] https://www.hopkinsmedicine.org/health/wellness-and-prevention/low-sodium-diet-and-lifestyle-changes-for-high-blood-pressure#

[24] https://pubmed.ncbi.nlm.nih.gov/16940454/#

[25] https://www.tandfonline.com/doi/full/10.1080/14656566.2016.1215430#d1e184

[26] https://www.hopkinsmedicine.org/health/conditions-and-diseases/primary-aldosteronism#

[27] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[28] https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

[29] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[30] https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure

[31] https://www.hopkinsmedicine.org/health/conditions-and-diseases/primary-aldosteronism

[32] https://www.cedars-sinai.org/health-library/diseases-and-conditions/w/white-coat-hypertension-and-masked-hypertension.html

[33] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417

[34] https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417