Abstract
To compare 24-hour ambulatory blood pressure (ABP) between women with polycystic ovary syndrome (PCOS) and ovulatory controls, and to explore potential anthropometric, hormonal, metabolic, and inflammatory correlates of ABP in women with PCOS. In this cross-sectional study, 50 women with PCOS (diagnosed by Rotterdam criteria) and 50 ovulatory controls underwent office and 24-hour ABP monitoring. Clinical, anthropometric, hormonal, metabolic, and inflammatory parameters were assessed. Between-group comparisons were adjusted for body mass index (BMI). LASSO regression was used to identify variables independently associated with ABP in the PCOS group. Women with PCOS showed significantly higher 24-hour and daytime mean arterial pressure and heart rate compared to controls, even after adjustment for BMI (p < 0.05). No differences were observed in nighttime ABP or office blood pressure (p > 0.05). PCOS participants exhibited a more adverse cardiometabolic profile, including higher BMI, waist circumference, insulin, HbA1c, triglycerides, creatinine, and TNF-alfa, along with lower estradiol and progesterone levels. In LASSO models, BMI emerged as the only consistent independent predictor of ABP across all periods. Additional predictors, such as HbA1c (nighttime mean BP), creatinine (daytime diastolic BP), and waist circumference (daytime systolic BP), were retained in specific models, while most hormonal, metabolic, and inflammatory markers were not associated with ABP in the PCOS group. In summary, women with PCOS exhibit higher 24-hour and daytime ABP compared to ovulatory controls, independently of BMI. Adiposity, as assessed by BMI, appears to be a key factor associated with ABP in this population. These findings highlight the importance of 24-hour ABP monitoring and weight management in the cardiovascular risk assessment and care of women with PCOS.
Data availability
All data generated or analyzed during this study are included in this published article and its supplementary information files.
References
Teede, H. J. et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil. Steril. 110, 364–379. https://doi.org/10.1016/j.fertnstert.2018.05.004 (2018).
Azziz, R. et al. The androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report. Fertil. Steril. 91, 456–488. https://doi.org/10.1016/j.fertnstert.2008.06.035 (2009).
Sprung, V. S. et al. Endothelial function measured using flow-mediated dilation in polycystic ovary syndrome: a meta‐analysis of the observational studies. Clin. Endocrinol. (Oxf). 78, 438–446. https://doi.org/10.1111/j.1365-2265.2012.04490.x (2013).
Bril, F. et al. Adipose tissue dysfunction in polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 109, 10–24. https://doi.org/10.1210/clinem/dgad356 (2023).
Lim, S. S. et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta‐regression. Obes. Rev. 20, 339–352. https://doi.org/10.1111/obr.12762 (2019).
Wekker, V. et al. Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis. Hum. Reprod. Update. 26, 942–960. https://doi.org/10.1093/humupd/dmaa029 (2020).
Tay, C. T. et al. 2023 International evidence-based polycystic ovary syndrome guideline update: insights from a systematic review and meta‐analysis on elevated clinical cardiovascular disease in polycystic ovary syndrome. J. Am. Heart Assoc. 13 https://doi.org/10.1161/JAHA.123.033572 (2024).
Berni, T. R., Morgan, C. L. & Rees, D. A. Women with polycystic ovary syndrome have an increased risk of major cardiovascular events: a population study. J. Clin. Endocrinol. Metab. 106, e3369–e3380. https://doi.org/10.1210/clinem/dgab392 (2021).
Amiri, M., Ramezani Tehrani, F., Behboudi-Gandevani, S., Bidhendi-Yarandi, R. & Carmina, E. Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Reprod. Biol. Endocrinol. 18 (23). https://doi.org/10.1186/s12958-020-00576-1 (2020).
Wu, C. H. et al. Hypertension risk in young women with polycystic ovary syndrome: A nationwide population-based cohort study. Front. Med. 7 https://doi.org/10.3389/fmed.2020.574651 (2020).
Azevedo, M. F. & de Elevated blood pressure in women with polycystic ovary syndrome: prevalence and associated risk factors. Rev. Bras. Ginecol. E Obs. 33, 31–36. https://doi.org/10.1590/s0100-72032011000100005 (2011). CostaE.C.Oliveira, A.I.N.; Silva, I.B. de O.; Marinho, J.C.D.B.; Rodrigues, J.A.M.; Azevedo.
Macut, D. et al. Hypertension in polycystic ovary syndrome: novel insights. Curr. Hypertens. Rev. 16, 55–60. https://doi.org/10.2174/1573402115666190531071422 (2020).
Yang, W. Y. et al. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes. JAMA 322, 409. https://doi.org/10.1001/jama.2019.9811 (2019).
Zhang, D. Y. et al. Ambulatory blood pressure monitoring, European guideline targets, and cardiovascular outcomes: an individual patient data meta-analysis. Eur. Heart J. 46, 2974–2987. https://doi.org/10.1093/eurheartj/ehaf220 (2025).
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. 11, 23–28. https://doi.org/10.1093/oxfordjournals.humrep.a019028 (1996).
Sampson, M., Kong, C., Patel, A., Unwin, R. & Jacobs, H. S. Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI-1) activity in lean women with and without the polycystic ovary syndrome. Clin. Endocrinol. (Oxf). 45, 623–629. https://doi.org/10.1046/j.1365-2265.1996.00863.x (1996).
Luque-Ramírez, M., Álvarez-Blasco, F., Mendieta-Azcona, C., Botella-Carretero, J. I. & Escobar-Morreale, H. F. Obesity is the major determinant of the abnormalities in blood pressure found in young women with the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 92, 2141–2148 (2007). 10.1210/jc.2007 – 0190.
Luque-Ramírez, M. et al. Office blood pressure, ambulatory blood pressure Monitoring, and echocardiographic abnormalities in women with polycystic ovary syndrome. Hypertension 63, 624–629. https://doi.org/10.1161/HYPERTENSIONAHA.113.02468 (2014).
Gui, J. & Wang, R. Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod. Biomed. Online. 35, 113–120. https://doi.org/10.1016/j.rbmo.2017.03.018 (2017).
de Sá, J. C. F. et al. Analysis of heart rate variability in polycystic ovary syndrome. Gynecol. Endocrinol. 27, 443–447. https://doi.org/10.3109/09513590.2010.501881 (2011).
Soleimani, H. et al. Predictive accuracy of 24-hour ambulatory blood pressure monitoring versus clinic blood pressure for cardiovascular and all-cause mortality: a systematic review and meta-analysis. Curr. Hypertens. Rev. 21, 102–116. https://doi.org/10.2174/0115734021337639250203175636 (2025).
Rotterdam, E. S. H. R. E. & ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 19, 41–47. https://doi.org/10.1093/humrep/deh098 (2004).
Grupo de Trabalho, M. A. P. A. & Grupo de Trabalho, M. R. P. A. V Brazilian guidelines for ambulatory monitoring of arterial pressure and III Brazilian guidelines for home monitoring of blood pressure. J. Bras. Nefrol. 33, 365–388. https://doi.org/10.1590/S0101-28002011000300013 (2011).
Barroso, W. K. S. et al. Jr. et al. Brazilian guidelines of hypertension – 2020. Arq. Bras. Cardiol. 116, 516–658. https://doi.org/10.36660/abc.20201238 (2021).
Acknowledgements
The authors would like to thank the PCOS and control women who volunteered to participate in this study and Professor PhD. George Dantas Azevedo.
Author information
Authors and Affiliations
Contributions
MFA, GDA and ECC, conceptualization of research project; MFA, AKCR, LMBM, LMBM, and RLAC investigation and data curation; MFA and ECC formal analysis and main manuscript text; GDA and ECC, writing—Review & Editing. ECC, supervision; MFA, project administration; All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
de Fátima Azevedo, M., Rocha, A.K.C., de Melo, L.M.B. et al. 24-hour ambulatory blood pressure and associated factors in women with polycystic ovary syndrome compared with ovulatory controls. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38731-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-38731-0
