24-hour ambulatory blood pressure and associated factors in women with polycystic ovary syndrome compared with ovulatory controls

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.