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Table 1 Characteristics of studies included in the meta-analysis

From: Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression

First author, year

Country

Study design

PCOS criteria

(a) BP measurement methods and standard conditions (b) Medication for hypertension (c) Diabetes status

PCOS group characteristics

Control group characteristics

Unadjusted RR (95% CI)

Quality assessment

Caldernon-Margalit et al. (2014) [2]

USA

Population based prospective cohort

NIH

(a) Not reported

(b) Not reported

(c) 7.3% diabetic in PCOS and 5.4% in control groups

N = 55

Age:45.4 (3.44); BMI: 29.3 (6.5)

N = 668

Age:45.40 (3.57); BMI: 29.90 (4.73)

1.03 (0.57, 1.85)

High

Chan et al. (2013) [34]

Australia

Case-control

Rotterdam

(a) Not reported

(b) Not reported

(c) 0% diabetic in PCOS vs. 3.7% in control groups

N = 109

Age = not reported; BMI = 31.6 (1.5)

N = 133

Age = not reported; BMI = 25.5 (1.40)

1.49 (0.64, 3.46)

Moderate

Chang et al. (2011) [35]

USA

Population based cross-sectional

Rotterdam

(a) Not reported

(b) Not reported

(c) 9% diabetic in PCOS and 8% in control groups

N = 144

Age = 40 (37–42)*; BMI = 31.7 (26.5–38.1)*

N = 170

Age = 42 (39–45)*; BMI = 28.7 (25.5–33.9)*

1.55 (1.03, 2.34)

High

Chang et al. (2016) [3]

USA

Population based cross-sectional

Rotterdam

(a) Not reported

(b) Not reported

(c) 9.4% diabetic in PCOS vs. 9.3% in control groups

N = 117

Age = 40.6¥; BMI = 31.06¥

N = 204

Age = 39.82¥; BMI = 31.43¥

1.51 (1.0005, 2.28)

Moderate

Dahlgren et al. (1992) [4]

Sweden

Prospective cohort study

Laparoscopic PCOS criteria

(a) Not reported

(b) Not reported

(c) 31.1% diabetic in PCOS vs. 4.8% in control groups

Group 1 (reproductive): N = 18

Age = 45.9 (2.5); BMI = no reported

Group 22 (Menopause/aging): N = 15

Age = 55.1 (2.6); BMI = no reported

Group 1: N = 57

Age = 46 (2.2); BMI = No reported

Group 2: N = 75

Age = 55.6 (3.1); BMI = no reported

RR for group 1:

7.9 (1.68, 37.16)

RR for group 2:

3.8 (1.91, 7.55)

Moderate

Ding et al. (2018) [7]

Taiwan

Population based prospective cohort

ICD

(a) Note reported

(b) Not reported

(c) 2.94% diabetic in PCOS and 1.46% in control groups

N = 8048

Age = 28.11 (6.89); BMI = not reported

N = 32,192

Age = 28.11 (6.90); BMI = not reported

2.02 (1.73, 2.36)

High

Gateva et al. (2012) [5]

Bulgaria

Cross-sectional

Rotterdam

(a) Not reported

(b) Not reported

(c) Not reported

N = 81

Age = mean 25.98€; BMI = 36.21 (4.58)

N = 125

Age = 26.5 (5.47); BMI = 37.55 (5.95)

0.95 (0.58, 1.55)

Moderate

Glintborg et al. (2015) [36]

Denmark

Population based cohort

Rotterdam

(a) Not reported

(b) 14% in PCOS and 6.7 in control groups

(c) 2.24% in PCOS vs. 0.4% in control group

N = 20,416

Age = 29.3 (8.5); BMI = 27.3 (23.0–32.7) *

N = 57,483

Age = 30.6 (9.6); BMI = 27.3 (23.0–32.7) *

2.80 (2.44, 3.21)

Moderate

Haakova et al. (2003) [49]

Czech Republic

Case-control

NIH

(a) Not reported

(b) Not reported

(c) 13.64% in PCOS vs. 9.09% in control groups

N = 66

Age = 29.9 (2.97); BMI = 23.7 (4.27)

N = 66

Age = 29.8 (4.94); BMI = 23.2 (3.89)

1.0 (0.06, 15.55)

Moderate

Hart et al. (2015) [37]

Australia

Population based retrospective cohort

ICD

(a) Not reported

(b) Not reported

(c) 12.5% in PCOS vs. 3.8% in control group

N = 2560

Age = not reported; BMI = not reported

N = 25,660

Age = not reported; BMI = not reported

5.12 (4.05, 6.48)

High

Iftikhar et al. (2012) [50]

USA

Retrospective cohort

Rotterdam

(a) Not reported

(b) Not reported

(c) 0.7% in PCOS vs. 2.6% in control

N = 309

Age = not reported; BMI = 29.4 (7.77)

N = 343

Age = not reported; BMI = 28.3 (7.47)

1.22 (0.93, 1.61)

High

Lo et al. (2006) [38]

USA

Population based cross-sectional

ICD

(a) Not reported

(b) Not reported

(c) 9% in PCOS vs. 1.9% in control

N = 11,035

Age = 30.7 (7.2); BMI = not reported

N = 55,175

Age = 30.8 (7.5); BMI = not reported

2.49 (2.35, 2.64)

High

Lunde et al. (2007) [51]

Norway

Prospective cohort

Laparoscopic PCOS criteria

(a) Not reported

(b) Not reported

(c) 0.74% in PCOS vs. 0% in control

N = 131

Age = mean 24.7€; BMI = 24.7

(17.0–36.9) *

N = 723

Age = not reported; BMI = not reported

1.1 (0.43, 2.3)

Moderate

Merz et al. (2016) [19]

USA

Population based prospective cohort

NIH

(a) Not reported

(b) Not reported

(c) 24% in PCOS vs. 32.2% in control

N = 25

Age = 62.6 (11.6); BMI = 28.7 (5.9)

N = 270

Age = 64.8 (9.8); BMI = 30.0 (6.7)

0.76 (0.50, 1.15)

High

Meun et. (2018) [39]

Netherlands

Population based prospective cohort

NIH

(a) Blood pressure was measured twice at the right brachial artery in sitting position with a random-zero sphygmomanometer

(b) Not reported

(c) 18.9% in PCOS vs. 7% in control

N = 106

Age = 69.57 (8.72); BMI = 27.92 (4.53)

N = 171

Age = 69.20 (8.60); BMI = 26.84 (3.83)

1.06 (0.89, 1.26)

High

Okoroh et al. (2015) [40]

USA

Population based cross-sectional

ICD

(a) Not reported

(b) Not reported

(c) 4.6% in PCOS vs. 1.9% in control

N = 125,268

Age = mean 33.4€; BMI = not reported

N = 250,536

Age = mean 33.4€; BMI = not reported

2.33 (2.28, 2.38)

High

Schmidt et al. (2011) [52]

Sweden

Prospective cohort

Rotterdam

(a) Blood pressure was measured (right arm, supine position) after 15 min rest.

(b) Not reported

(c) 22% in PCOS vs. 14% in control

N = 32

Age = not reported; BMI = not reported

N = 95

Age = not reported; BMI = not reported

1.67 (1.20, 2.33)

Moderate

Shi et al. (2014) [53]

China

Retrospective cohort

Rotterdam

(a) Blood pressure were determined from two blood pressure readings taken at 30-min intervals with the subject seated quietly.

(b) Not reported

(c) Not reported

N = 3396

Age = 30.49 (4.01); BMI = 24.97 (4.15)

N = 1891

Age = 30.73 (4.86); BMI = 22.69 (3.26)

1.61 (1.40, 1.85)

Moderate

Shroff et al. (2007) [10]

USA

Case-control

Rotterdam

(a) Mean systolic and diastolic blood pressure was assessed with two readings after 5 min of seated rest.

(b) Not reported

(c) 4.2% in PCOS vs. 0% in control group

N = 24

Age = 32 (6.5); BMI = 36 (5.4)

N = 24

Age = 36 (7.2); BMI = 35 (3.3)

1.5 (0.27, 8.25)

Moderate

Sirmans et al. (2014) [41]

USA

Population based cross-sectional

ICD

(a) Not reported

(b) Not reported

(c) 17.6% in PCOS vs. 4.7% in control group

N = 1689

Age = mean 25.24€; BMI = not reported

N = 5067

Age = mean 25.23; BMI = not reported

2.58 (2.45, 3.32)

Moderate

Vrbíková et al. (2003) [54]

Czech Republic

Cross-sectional

NIH

(a) Two blood pressure (BP) readings were obtained in sitting patients after a 10 min rest; the mean was determined from two values and was used for further analysis.

(b) Not reported

(c) 3.1% in PCOS vs. 0% in control group

N = 50

Age = 30.7 (4.2); BMI = 29.20 (7.10)

N = 335

Age = 29.9 (3.10); BMI = 24.10 (4.50)

2.73 (1.46, 5.11)

Moderate

Wild et al. (2000) [57]

UK

Population based retrospective cohort

Laparoscopic criteria

(a) Sitting blood pressures were measured twice in the right arm after participants had been resting for 5 min. Mean values for each individual were used in the analyses.

(b) Not reported

(c) 6.9% in PCOS vs. 3% in control group

N = 1060

Age = not reported; BMI = mean 25.9€

N = 319

Age = not reported; BMI = mean 26.6

1.2 (0.95, 1.52)

High

Bird et al. (2013) [43]

Canada

Population based cohort

ICD

(a) Not reported

(b) 6.6 in PCOS vs. 7.1 in control

(c) 20.3% in PCOS vs. 20.7% in control group

N = 43,506

Age = 28.7€; BMI = not reported

N = 43,506

Age = 28.9€; BMI = not reported

1.27 (1.22, 1.32)

Moderate

Li et al. (2013) [44]

China

Population based cross-sectional

Rotterdam

(a) Not reported

(b) Not reported

(c) Not reported

N = 833

Age = 29.1 (5.4); BMI = 22.2 (4.2)

N = 2732

Age = 32.3 (6.1); BMI = 22.2 (3.4)

1.004 (0.84, 1.20)

High

Ramezani Tehrani et al. (2015) [58]

Iran

Population based prospective cohort

NIH

(a) BP were measured twice on the right arm with the subject in a seated position with a standard mercury sphygmomanometer after the subject sat for 15 min; the mean of these 2 measurements was recorded

(b) Not reported

(c) Not reported

N = 85

Age = 29.8 (9.2); BMI = 27.2 (5.3)

N = 552

Age = 29.3 (9.0); BMI = 25.6 (5.0)

1.39 (0.60, 3.23)

High

Luque-Ramirez et al. (2007) [55]

Spain

Case-control

AES

(a) Ambulatory blood pressure monitoring

(b) Not reported

(c) Not reported

N = 36

Age = 24.2 (6.2); BMI = 29.3 (6.4)

N = 20

Age = 26.7 (6.8); BMI = 28.2 (6.9)

0.83 (0.41, 1.68)

Moderate

Ramezani Tehrani et al. (2011) [46]

Iran

Population based cross-sectional

Rotterdam

(a) Not reported

(b) Not reported

(c) Not reported

N = 136

Age = 32.4 (25.9–38.8)*; BMI = 25.9 (23.5–32.6)*

N = 423

Age = 36 (30–41.0) *; BMI = 26.4 (23.1–29.4) *

1.04 (0.29, 3.79)

High

Ramezani Tehrani et al. (2014) [47]

Iran

Population based cross-sectional

Rotterdam

(a) BP were measured twice on the right arm with the subject in a seated position with a standard mercury sphygmomanometer after the subject sat for 15 min; the mean of these 2 measurements was recorded

(b) Not reported

(c) Not reported

N = 85

Age = 29.02 (7.4)*; BMI = 26.5 (5.8)

N = 517

Age = 33.9 (7.6); BMI = 26.6 (5)

0.68 (0.09, 5.20)

High

Marchesan et al. (2019) [56]

Brazil

Cross-sectional

Rotterdam

(a) Blood pressure (measured after a 10-min rest, in the sitting position, with feet on the floor and the arm supported at heart level

(b) Not reported

(c) Not reported

N = 180

Age = 25 (21–29)*; BMI =32.52 (7.41)

N = 70

Age = 29 (26–34)*; BMI =28.71 (5.71)

2.29 (1.20, 4.37)

High

Behboudi-Gandevani et al. (2018) [48]

Iran

Population based cohort study

NIH

(a) BP were measured twice on the right arm with the subject in a seated position with a standard mercury sphygmomanometer after the subject sat for 15 min; the mean of these 2 measurements was recorded

(b) Not reported

(c) 1.1% in PCOS vs. 2.1% in control group

Group 1 (reproductive): N = 131

Age = 25.28 (7.69); BMI =25.89 (5.13)

Group 2 (Menopause/aging): N = 28

Age = 46.19 (11.02); BMI =29.53 (4.51)

Group 1: N = 1046

Age = 26.57 (7.51); BMI = 24.89 (4.9)

Group 2: N = 355

Age = 49.46 (6.26); BMI = 29.32 (4.57)

Group 1: 1.29 (0.89, 1.87)

Group 2: 1.01 (0.61–1.68)

High

  1. Abbreviations: PCOS Polycystic ovary syndrome, N Number, RR Relative risk, CI Confidence interval, NIH National Institutes of Health, ICD International Classification of Diseases
  2. *Values represent median and interquartile
  3. € Values represent mean; standard deviation is not reported
  4. ¥ Values represent median; interquartile range is not reported