Risk Factors for Hypertension in Polycystic Ovary Syndrome: Evidence from a Retrospective Study

<b>Background</b>: Polycystic ovarian syndrome (PCOS) is a common female endocrinopathy, but its interrelations with arterial hypertension (AH) are still debatable. Therefore, the present study aims to explore the risk factors for hypertension in a large group of well-phenotyped women with PCOS. <b>Methods</b>: The data of 1047 Bulgarian PCOS patients diagnosed according to Rotterdam criteria in the period 2005-2022 were studied retrospectively. The risk factors for hypertension were estimated in the PCOS women with different phenotypes. <b>Results</b>: The prevalence of AH was 17.6% among the PCOS women, with 4.2% of them being on antihypertensive treatment. The AH prevalence was increased in women with the "classic" phenotype compared to others (18.9% vs. 12.9%, <i>p</i> = 0.037). The most important risk factors associated with hypertension were the presence of diabetes mellitus type 2 (DMT2), obesity, family history of AH, and age ≥ 30 years (<i>p</i> < 0.001). The prevalence of impaired glucose tolerance (IGT) but not impaired fasting glucose was also related to the development of AH. <b>Conclusions</b>: The leading independent factors associated with hypertension in PCOS patients are the presence of DMT2, IGT, obesity, family history of hypertension, and age, but not the degree of hyperandrogenism. Population-based studies, including distinct ethnic groups, are needed to reveal the pathophysiology and the optimal clinical management of AH in PCOS.