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

Abstract

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. Cross-sectional study. Research center. Biobanked samples obtained from 233 women with PCOS and 70 controls without hirsute, ovulatory dysfunction. Metabolic, hormonal, and biochemical assessment. Blood pressure status according to 2017 ACC/AHA and JNC7 criteria and prevalence of metabolic abnormalities. 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 130-139mmHg and/or diastolic blood pressure 80-89mmHg), 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 ≥100mg/dL (prevalence ratio 3.88, 95% confidence interval [CI] 1.30-11.55), high-density lipoprotein (HDL) <50mg/dL (prevalence ratio 2.13, 95% CI 1.45-3.12), and triglycerides ≥150mg/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 ≥100mg/dL, prevalence ratio 1.38, 95% CI 0.99-1.91), HDL <50mg/dL (prevalence ratio 1.1, 95% CI 0.99-1.37), and triglycerides ≥150mg/dL (prevalence ratio 1.48, 95% CI 1.13-1.94). 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.