PCOS, race, and obesity drive hypertension and metabolic risk

The odds of having hypertension (HTN) and pre-metabolic syndrome (MetS) are significantly increased in nonobese non-Hispanic Black (NHB) women vs other races, independent of polycystic ovary syndrome (PCOS), according to a recent study published in the Journal of Women's Health.¹

Women with PCOS are more likely to present with known risk factors and predictors of cardiovascular disease (CVD), which is the leading cause of death among US women.² Additionally, obesity and hormonal dysfunction have an interplay as mediators of CVD in PCOS patients, highlighting the need to independently assess obesity’s role for CVD risk.¹

“Data examining racial and ethnic differences in HTN in women with PCOS are limited,” wrote investigators. “Black women with PCOS have higher body mass index (BMI) and are at an increased risk of CVD and HTN compared with White women with PCOS, despite having more favorable lipid profiles.”

Blood pressure, BMI, and demographic measures

The case-control study was conducted to determine the severity of obesity in reproductive-aged women with PCOS. International Classification of Diseases, Tenth Revision diagnostic codes for PCOS, tubal infertility, and male factor infertility were used to identify cases.

Participants included women aged at least 18 years receiving care between October 2011 and December 2021 with available blood pressure (BP) and body mass index (BMI) data. Exclusion criteria included a lack of diagnosis, BP, or BMI data.

Both systolic BP and diastolic BP information were obtained, alongside participant demographics and clinical characteristics. Race and ethnicity categories included NHB, non-Hispanic White, and Hispanic.

Obesity categories

Patients with both obesity and either pre-HTN or HTN were classified as being pre-MetS. Additionally, those with a BMI of 30 or greater were classified as obese. Classes of obesity included:

• Class 1 obesity at 30 to under 35 kg/m²
• Class 2 obesity at 35 to under 40 kg/m²
• Class 3 obesity at 40 kg/m² or greater

Underweight, normal weight, and overweight classifications were also given to nonobese patients. Indices of elevated BP included Stage 1 HTN, Stage 2 HTN, and overall HTN.

A reduced age and a significant increase in BMI were reported in PCOS patients vs non-PCOS patients. These patients also presented with significantly greater Stage 1 HTN among the population with obesity alone, with an odds ratio (OR) of 1.37.

Hypertension risk in obese vs nonobese PCOS patients

While PCOS was not associated with continuous BP indices in nonobese patients, links remained in obese patients after adjusting for demographic characteristics. Adjusted ORs for overall HTN and Stage 1 HTN in PCOS patients with obesity were 1.36 and 1.41, respectively.

PCOS patients also had an OR of 2.12 for obesity, 0.71 for class 1 obesity, 1.48 for class 2 obesity, and 5.13 for class 3 obesity. These odds significantly increased when adjusting for age, NHB race, and ethnicity, with a 6-fold increased risk of class 3 obesity among PCOS cases vs controls.

Pre-MetS criteria were also more commonly met in PCOS patients, with an OR of 1.65. The risk was increased 2-fold in these patients after adjusting for age, NHB race, and Hispanic ethnicity.

Independent influence of NHB race

In nonobese patients, an adjusted OR for overall HTN of 1.57 was reported for NHB race and ethnicity, highlighting a significant increase in risk among this population. A significant link was also reported between NHB race and meeting pre-MetS criteria regardless of PCOS diagnosis, with an adjusted OR of 1.83.

“We demonstrate that diagnosis of PCOS is associated with a predisposition to CVD risk as reflected in elevated BP indices and increased odds of meeting criteria for [HTN],” wrote investigators.

References

1. Okifo F, Pal L, Mushi M, Stachenfeld N. Diagnosis of polycystic ovary syndrome and non-Hispanic Black race are predictive of hypertension in reproductive age women with polycystic ovary syndrome. Journal of Women’s Health. 2025;34(12). doi:10.1177/15409996251376161
2. Garcia M, Mulvagh SL, Merz CN, Buring JE, Manson JE. Cardiovascular disease in women: clinical perspectives. Circ Res. 2016;118(8):1273-93. doi:10.1161/CIRCRESAHA.116.307547