Effects of metformin versus ethinyl-estradiol plus cyproterone acetate on ambulatory blood pressure monitoring and carotid intima media thickness in women with the polycystic ovary syndrome

ObjectiveTo compare the effects of metformin versus an antiandrogenic contraceptive pill on ambulatory blood pressure monitoring (ABPM) and carotid intima media thickness (CIMT) in women with polycystic ovary syndrome (PCOS).DesignClinical randomized trial.SettingAcademic hospital.Patient(s)Thirty-four consecutive PCOS patients.Intervention(s)PCOS patients randomized to oral treatment with metformin (n = 19) or with Diane35 Diario pill (n = 15) for 24 weeks.Main Outcome Measure(s)ABPM recordings and ultrasound measurements of CIMT as marker of subclinical atherosclerosis obtained at baseline and after treatment.Result(s)Metformin resulted in reductions in daytime and 24-hour average systolic and diastolic blood pressure whereas Diane35 Diario induced a slight increase in these parameters. Compared with a nonhyperandrogenic control group, the increased CIMT values of PCOS patients decreased to the normal range after treatment with either metformin or Diane35 Diario.Conclusion(s)Metformin treatment decreased daytime ABPM recordings whereas Diane35 Diario exerted the opposite effect. The safer blood pressure profile of metformin should be considered in PCOS patients who present with a history of hypertension or who are at risk for this disorder. Treatment with either Diane35 Diario or metformin improved CIMT mean values.