Combined androgen excess polycystic ovary syndrome and obesity are associated with elevated beat-to-beat blood pressure variability in adult women.

Androgen excess polycystic ovary syndrome (AE-PCOS) is associated with elevated risk for hypertension and cardiovascular disease. Greater beat-to-beat blood pressure variability (BPV) has emerged as a novel marker of cardiovascular risk. Little is known about beat-to-beat BPV in AE-PCOS, but prior studies suggest blunted baroreflex sensitivity (BRS), a major contributor to beat-to-beat BP regulation. Both obesity and androgen excess are implicated as driving factors of cardiovascular risk in AE-PCOS. We hypothesized that 1) beat-to-beat BPV would be greater in AE-PCOS compared with both women with overweight/obesity (OW/OB) and lean controls; 2) beat-to-beat BPV would be augmented in OW/OB compared with lean controls. We measured beat-to-beat BP (finger photoplethysmography) during ∼5-10 min of supine rest in 18 lean controls, 14 OW/OB controls, and 14 women with AE-PCOS. Serum testosterone was measured and spontaneous cardiovagal BRS was assessed via sequence technique. In AE-PCOS, resting blood pressure (BP) was greater than lean controls (P < 0.05) and serum testosterone greater than both control groups (P < 0.001). Diastolic BP standard deviation was greater in AE-PCOS (3.9 ± 1.0 mmHg) compared with both control groups (lean: 3.0 ± 1.5 mmHg; OW/OB: 2.9 ± 1.2 mmHg; P = 0.007). Cardiovagal BRS was not different between groups (P = 0.196). Neither cardiovagal BRS nor serum testosterone were related to beat-to-beat BPV in AE-PCOS. Collectively, these data suggest greater beat-to-beat BPV in AE-PCOS, which cannot be accounted for by obesity alone and is not associated with cardiovagal BRS or circulating androgens. NEW & NOTEWORTHY This is the first study to comprehensively examine beat-to-beat blood pressure variability (BPV) in women with androgen excess polycystic ovary syndrome (AE-PCOS). Our results suggest early alteration(s) in beat-to-beat BPV in women with AE-PCOS before the manifestation of overt cardiovascular disease, which cannot be fully accounted for by coincident obesity alone and is not associated with cardiovagal baroreflex sensitivity or androgen excess.