Title: Hypertension in polycystic ovary syndrome: is it my hormones?:The impact of hyperandrogenism on sympathetic vasoconstriction and blood pressure regulation.
Funder: The Academy of Medical Sciences

Abstract: This project aims to: 1.Investigate whether impaired sympathetic nervous regulation of vasoconstrictor tone is evident in PCOS patients and hyperandrogenic girls. 2.Establish whether hyperandrogenism impacts sympathetic vasoconstriction in PCOS patients and hyperandrogenic girl. To achieve these aims, the following objective has been set: Quantify sympathetic vasoconstriction in PCOS patients and hyperandrogenic girls before and after androgen blockade. The NHS cost-burden of hypertension is £2.1 billion per year. Currently, all treatment strategies for hypertension are developed based on male data due to the structural gender bias in clinical trials, and chronic underfunding for female specific research. PCOS affects ~18% of women, and carries an increased susceptibility to developing hypertension, which contributes to the ever-increasing cost-burden. However, the mechanisms responsible for this pathology and appropriate treatment strategies have never been investigated. Hypertension causes end organ damage and increases the risk of cardiovascular disease by 75%. Blood pressure regulation depends on sympathetic nerve activity, but chronic overactivity can cause hypertension by increasing vasoconstrictor tone. Sympathetic overactivity could be driven by PCOS induced hyperandrogenism. Importantly, this excess is evident before adulthood in girls who may develop PCOS and could confer serious long-term risk. This project will assess the impact of androgens on sympathetic nervous system control of blood pressure in PCOS patients and hyperandrogenic girls. This will enable clinicians to employ effective prevention strategies for hypertension in PCOS patients, reducing cost-burden for the NHS and long-term cardiovascular disease risk for these women.

Lay abstract: Hypertension (high blood pressure) costs £2.1 billion per year for our NHS, and causes damage to vital organs meaning you are 75% more likely to develop other heart and blood vessel disease. Hypertension in women is sometimes caused by polycystic ovary syndrome (PCOS). PCOS affects up to 20% of all women in the UK, and can also result in problems getting pregnant. Normally, everyone’s blood pressure is controlled by the nervous system, but overactivity of the ‘fight of flight’ arm of this control system is one of the causes of hypertension. As yet, however, we don’t know whether this is true in PCOS patients. The condition is known to disrupt the normal balance of hormones that are thought to influence the nervous system activity, and could have a detrimental impact on blood pressure. Importantly, PCOS patients are often not diagnosed until they try to conceive, but these hormonal changes happen during the adolescent period and may disrupt blood pressure regulation and increase disease risk from an early age. This project will be the first to assess blood pressure regulation in girls with high androgens and in PCOS patients before and after drug intervention to block the effect of androgen hormones. This research will work out how much influence these hormone changes have on blood pressure regulation in PCOS. Understanding these things is crucial for successful treatment, preventing deaths and reducing NHS cost-burden from PCOS patients with hypertension.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health categories: CARDIOVASCULAR;REPRODUCTIVE HEALTH AND CHILDBIRTH