ACC/AHA 2017 definition of high blood pressure: implications for women with polycystic ovary syndrome

Abstract

Objective: To assess the association of insulin resistance markers, body mass index (BMI), age, and androgen levels with systemic arterial hypertension (SAH) defined according to 2017 American College of Cardiology/American Heart Association (ACC/AHA) criteria in polycystic ovary syndrome (PCOS); and to determine the risk of metabolic abnormalities in the presence of SAH defined by both the 2017 ACC/AHA and Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) criteria in women with PCOS.

Design: Cross-sectional study.

Setting: Research center.

Patient(s): Biobanked samples obtained from 233 women with PCOS and 70 controls without hirsute, ovulatory dysfunction.

Intervention(s): Metabolic, hormonal, and biochemical assessment.

Main outcome measure(s): Blood pressure status according to 2017 ACC/AHA and JNC7 criteria and prevalence of metabolic abnormalities.

Result(s): The prevalence of SAH among women with PCOS was 65% (n = 152) using 2017 ACC/AHA criteria and 26.6% (n = 62) considering JNC7 criteria. The 90 women whose SAH status was changed by 2017 ACC/AHA criteria were categorized as stage 1 SAH (systolic blood pressure 130-139 mmHg and/or diastolic blood pressure 80-89 mmHg), requiring nonpharmacologic therapy only (lifestyle changes). The prevalence of SAH in the control group was 41.4% (n = 29) according to 2017 ACC/AHA criteria and 12.8% (n = 9) according to JNC7 criteria. In all groups, SAH was associated with higher homeostasis model assessment and insulin levels compared with normal blood pressure (P<.01). In women with PCOS, the risk ratio for glucose ≥100 mg/dL (prevalence ratio 3.88, 95% confidence interval [CI] 1.30-11.55), high-density lipoprotein (HDL) <50 mg/dL (prevalence ratio 2.13, 95% CI 1.45-3.12), and triglycerides ≥150 mg/dL (prevalence ratio 3.39, 95% CI 1.56-7.35) was higher with SAH versus normal blood pressure when 2017 ACC/AHA criteria were applied, and did not increase or increased slightly when JNC7 criteria were applied (glucose ≥100 mg/dL, prevalence ratio 1.38, 95% CI 0.99-1.91), HDL <50 mg/dL (prevalence ratio 1.1, 95% CI 0.99-1.37), and triglycerides ≥150 mg/dL (prevalence ratio 1.48, 95% CI 1.13-1.94).

Conclusion(s): The risk of cardiometabolic co-morbidities was increased in women with SAH defined by 2017 ACC/AHA criteria. Lower cutoffs for abnormal blood pressure seem appropriate for women with PCOS, providing a simple screening tool for cardiometabolic co-morbidities and an opportunity for early primary prevention.

Keywords: Hypertension; androgen; cardiovascular diseases; insulin resistance; polycystic ovary syndrome.