Anti-Apoptotic Effect of Apelin in Human Placenta: Studies on BeWo Cells and Villous Explants from Third-Trimester Human Pregnancy.

Previously, we demonstrated the expression of apelin and G-protein-coupled receptor APJ in human placenta cell lines as well as its direct action on placenta cell proliferation and endocrinology. The objective of this study was to examine the effect of apelin on placenta apoptosis in BeWo cells and villous explants from the human third trimester of pregnancy. The BeWo cells and villous explants were incubated with apelin (2 and 20 ng/mL) alone or with staurosporine for 24 to 72 h. First, we analysed the dose- and time-dependent effect of apelin on the expression of apoptotic factors on the mRNA level by real-time PCR and on the protein level using Western blot. Next, we checked caspase 3 and 7 activity by Caspase-Glo 3/7, DNA fragmentation by the Cell Death Detection ELISA kit and oxygen consumption by the MitoXpress-Xtra Oxygen Consumption assay. We found that apelin increased the expression of pro-survival and decreased proapoptotic factors on mRNA and protein levels in both BeWo cells and villous explants. Additionally, apelin inhibited caspase 3 and 7 activity and DNA fragmentation in staurosporine-induced apoptosis as also attenuated oxidative stress by increasing extracellular oxygen consumption. The antiapoptotic effect of apelin in BeWo cells was mediated by the APJ receptor and mitogen-activated protein kinase (ERK1/2/MAP3/1) and protein kinase B (AKT). The obtained results showed the antiapoptotic effect of apelin on trophoblast cells, suggesting its participation in the development of the placenta.

Extensive squamous metaplasia (morulosis) of the endometrium as a clinical and pathological problem: a case report and literature study.

The article presents a case of a 28-year-old woman with so-called morulosis - a form of squamous metaplasia of the endometrium, which may mimic malignancy. The term 'morulosis' indicates extensive squamous mulberry-like metaplasia, which in a large part or nearly entirely affects endometrium, whereas in turn, benign squamous metaplasia or single morules, refers to a limited, usually small regional pathology of endometrium. Because the endometrial glands and stroma gradually undergo the process of squamous metaplasia, in a scanty biopsy material the picture may lead to overdiagnosis. In the epithelioid regions small inactive glands with an immunofenotype different from the remaining endometrium might be observed. So far 21 cases have been reported in English literature. The patients (age 19-45) had presented with abnormal bleeding, infertility or after hormonal therapy. The mechanism of the extensive squamous metaplasia of endometrium is still not clear. The prevailing view holds that morulosis appears to be a result of hormonal imbalance. To shed light on possible pathogenic background of morulosis, we present a case of particularly severe extensive squamous metaplasia of the endometrium (morulosis).

Cesarean scar pregnancy - various methods of treatment.

Ectopic pregnancy constitutes 2% of all pregnancies. In the last decades, due to the rising amount of caesarean sections, new localization of ectopic pregnancy has been observed - caesarean scar pregnancy (CSP). Cesarean scar pregnancy is an iatrogenic disease and a life-threatening condition which frequency will systematically rise. Because of possible serious complications, CSP should be swiftly diagnosed and treated. The purpose of this retrospective study was to demonstrate different methods of CSP treatment performed between 2015-2018 in the Clinic of Endocrinological Gynaecology and Gynaecology Jagiellonian University Medical College in Cracow. The clinical characteristics, diagnosis, various methods of treatment and clinical outcomes were analysed. Definitive algorithm of CSP treatment is still not established. Pharmacological and operative methods are approved while expectant observation is considered unsafe due to possible risk of complications for the patient, including death.

Blood pressure in postmenopausal women with a history of polycystic ovary syndrome.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder at reproductive age, affecting 6-10% of females in this group. The aetiology of this syndrome is not fully understood. Genetics, endocrinology factors, and the influence of the environment are possible causes of this syndrome. PCOS is characterised by menstrual disorders, hyperandrogenism, and abnormalities in ovarian morphology as well as metabolic disorders. PCOS increases the risk of overweight and obesity, diabetes, endometrial cancer, and cardiovascular diseases such as hypertension along with all its long-term consequences. There are limited studies about cardiovascular disorders, especially hypertension, in postmenopausal women with a history of PCOS. The presented paper is an attempt to briefly summarise literature data concerning the influence of this disease on the incidence of hypertension and blood pressure control in postmenopausal women. Women with PCOS more often present features of metabolic syndrome and have increased cardiovascular risk factors including hypertension. The prevalence of hypertension is 2.5 times higher than in corresponding healthy peers. Furthermore, hyperandrogenaemia is associated with elevated blood pressure independent of the patient's age, insulin resistance, obesity, and dyslipidaemia. In view of this, these patients should be thoroughly screened for hypertensive disorders and educated about the lifestyle modifications that could prevent hypertension later in life.

[Metformin­new potential medicine in pain treatment?]

Metformin, a drug of biguanide class, is now one of the most widely used drugs in the treatment of type 2 diabetes. It activates adenosine monophosphate-activated protein kinase (AMPK) and through AMPK activation, inhibits the mammalian target of rapamycin (mTOR) pathway. Recent literature has explored metformin as an option in pain management, given its role in the AMP-activated protein kinase (AMPK) pathway and its ability to modulate pain in animal models. Based on a variety of preclinical pain models, it is now clear that mTOR signaling plays a major role in the sensitization of the nervous system in chronic pain conditions. The activation of AMPK with metformin has led to decreased pain in neuropathic and postsurgical pain models, suggesting that these drugs and this mechanism of actin might be effective in humans. Despite the strong preclinical rationale, there are only very few data considered the utility of metformin as a potential pan therapeutic in humans. Further, randomized studies were needed to identify the role of metformin in pain perception and chronic pain conditions in humans.

[The influence of living conditions and lifestyle on the anxiety level in women in the postpartum period-questionnaire study].

Introduction: Due to the high incidence of postpartum anxiety disorders and their serious health and social consequences, it is essential to analyze the possible risk factors to identify groups of women particularly vulnerable to cover their proper care and control. The aim of our study was to investigate the relationship between the anxiety in women in the postpartum period, and their living conditions and lifestyle. Materials and Methods: The study was conducted from April to July 2016. We included 102 women in the postpartum period, living in the city of Cracow and the Cracow district. The study was based on a survey of our own authorship, State Anxiety Inventory (STAI) and the Jurczynski's Inventory of Health Behavior (IZZ). Results: The anxiety level in women in the postpartum period depends on the conditions of life and health behaviors. The level of health behavior of women in the postpartum period is an average and independent of age, number of children, and the material situation. Residents of cities, women with higher education, who planned pregnancy, have a higher level of health behavior. Good housing conditions have a positive influence on health behavior. Low levels of health behavior significantly affect the severity of maternal anxiety. Residents of the village, women with lower education and who not planning pregnancy have higher levels of anxiety during the postpartum period. Anxiety level of women in the postpartum period is inversely proportional to their housing conditions. Women with a job have lower levels of anxiety than non-working. The anxiety level in women in childbirth does not depend on age or financial situation. Conclusions: The anxiety level in women in the postpartum period, significantly depends on the living conditions and health behaviors. Verification of distinguished factors should be applied appropriately in health promotional activities and prevention programs.

Metformin and changes in serum lipid profile in lean patients with polycystic ovary syndrome.

Introduction: The aim of our study was to assess the values of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides before and after treatment with metformin in lean patients with polycystic ovary syndrome (PCOS). Material and Methods: 32 patients received metformin 1500 mg per day in three divided doses. Lipids measurements were performed twice: before and after 6 months of treatment with metformin. Results: In lean patients with PCOS after treatment with metformin we observed: statistically significant lower LDL-C levels (4.16±0.79 mmol/l vs 3.4±0.86 mmol/l, p<0.05) and triglycerides levels (1.8±0.53 mmol/l vs 1.12±0.64 mmol/l, p<0.05). We observed an increase in HDL values and a decrease in total cholesterol values, but these changes were not statistically significant (1.5±0.71 mmol/l vs 1.71±0.69 mmol/l, p=0.09; 5.87±0.92 mmol/l vs 5.69±0.97 mmol/l, p=0.11). Conclusion: Our study showed that treatment of 1500 mg metformin for about six months among PCOS women results in an improvement in serum lipid profiles. We observed a significant decrease in LDL-C and triglycerides values after metformin therapy.

Dysgerminoma and gonadoblastoma in the course of Swyer syndrome.

We present a case of a woman with primary amenorrhea. Ultrasound imaging showed a uterus of normal size but bands of connective tissues at the site of ovaries. A genetic test was done which revealed the XY karyotype. Swyer syndrome was diagnosed. The patient did not report for the follow-up visits. Three years later, the woman reported back because of increasing abdominal circumference. The patient underwent an operation. Radical hysterectomy was performed. Histopathological examination showed dysgerminoma and gonadoblastoma on the left gonad and dysgerminoma on the right one. This case report presents the natural history of Swyer syndrome.

Vascular effects of simvastatin are similar to hormone replacement therapy in postmenopausal women.

Aim of the study: To compare effect of six month transdermal 17 ß-estradiol supplementation with oral medroxyprogresterone acetate to oral simvastatin treatment on nitric oxide (NO), endothelin-1, ß-thromboglobulin, vascular endothelial growth factor (VEGF) and von Willebrand factor (vWF) levels during standard exercise test in post menopausal women. Patients and Methods: 32 women were included to the study. Group 1 treated with 17ß-estradiol combined with medroxyprogesterone. Group 2 treated with simvastatin, group 3 was the controls. VEGF plasma levels as well as basal and standard exercise test induced levels of vWF, NO, endothelin- 1, ß-thromboglobulin were measured at the beginning of the study, at 3rd and 6th month of the study. During standard exercise test these parameters were measured three times: at the beginning, at peak exercise and at the 15th minute of recovery. Results: 17ß-estradiol supplementation and simvastatin treatment reduced basal and exercise test induced endothelin-1 plasma level. 17ß-estradiol supplementation gradually increased NO release, whereas simvastatin initially reduced and finally increased nitric oxide release. NO/ET-1 ratio was increased at peak exercise and recovery time in group 1 whereas only at peak exercise in group 2. Basal VEGF plasma level and ß-thromboglobulin level at recovery time were reduced after 6 month of simvastatin therapy. Conclusion: Six months long oral simvastatin exerted beneficial influence on endothelial function equal to that of continuous transdermal 17ß-estradiol supplementation combined with medroxyprogesterone acetate. Simvastatin only exerted benefical effect on platelet function. The protective effect of both therapies was more pronounced during exercise and recovery time.

[The rapture of the spleen in a pregnant women with twins and HELLP syndrome: a case report].

The blunt abdominal trauma causes the liver and spleen injury mostly. The rupture of the spleen can also be caused by infectious diseases (mononucleosis), hematologic diseases (Non-Hodgin Lymphoma), rheumatologic diseases (Wegener's granulomatosis) or diseases of the spleen (splenic hemangioma, splenic artery aneurysm). Also the spontaneous rupture of the spleen can occur. In the literature we can find descriptions of the spontaneous splenic rupture during pregnancy and puerperium period. In the differential diagnosis of the bleeding into the peritoneal cavity, all possible causes, including those less frequent as spontaneous rupture of the spleen, should be taken into account. In the presented case report we describe the case of splenic rupture after caesarean section performed on a woman in a twin pregnancy with HELLP syndrome.

Plasma sICAM levels during standard exercise test are higher in postmenopausal women with mixed hyperlipemia. sICAM level in postmenopausal women.

Aim: Plasma sICAM, sVCAM, endothelin- 1 (ET-1), TNF-a, its soluble receptor levels and nitric oxide production evaluation during standard exercise test in postmenopausal women with mixed hyperlipidemia. Material and methods: 35 white, normotensive, non-smoking, postmenopusal women. Group A consisted of 24 women normal plasma cholesterol and triglicerides. Group B- 11 women hypercholesterolemic and hypertrigliceridemic. Basic fasting plasma FSH, 17b- -estradiol, total cholesterol, LDL-cholesterol, triglicerides, HDL-cholesterol were measured. Standard exercise test was carried out according to Bruce protocol. During the test blood samples were taken trice (prior to, at peak exercise, at15th minute of recovery). The sICAM, sVCAM, ET-1, TNF-a, its soluble receptor and secretion of nitric oxide were measured. Statistical analysis: Fisher test and t-Welch test were used. Results: There were no differences between groups A and B in mean plasma concentrations of FSH, estradiol and HDL-cholesterol. Mean plasma total cholesterol, triglicerides and LDL-cholesterol levels were higher in group B compared to group A. Plasma levels of sICAM prior to standard exercise test, at peak exercise and at the 15th minute of recovery were significantly lower in group A compared to group B. Mean plasma sVCAM levels did no differ between groups. NO3 plasma levels was significantly higher at peak exercise in group B compared to group A. There were no significant differences between groups in regard to mean plasma NO2, endothelin-1, TNF-a, and TNF-a receptor levels. Conclusion: Plasma soluble intracellular adhesion molecules levels are higher at rest and during exercise in postmenopausal women with atherosclerosis risk factors.

There is no difference in the plasma cortisol level between women with body mass index (BMI) greater than or equal 25 kg/m² and polycystic ovary syndrome and the control group without polycystic ovary syndrome and BMI 25 kg/m².

A 4-8% of women of reproductive age suffer from the polycystic ovary syndrome (PCOS). The clinical and/ or biochemical hyperandrogenemia is found up to 75% of women with PCOS. It is unclear whether the hyperandogenemia in PCOS is caused directly by this disorder or by obesity. The recent studies have shown that the cortisol level in PCOS patients can be elevated, decreased or comparable to the control group. The aim of our study was to assess the cortisol plasma level in women with body mass index greater than or equal to 25 kg/ m², with and without PCOS. The study population consisted of 17 overweight women with PCOS and 44 overweight women without PCOS. There were not statistically significant differences in the body mass (group 1: 88.9 ± 17.0 kg, vs. group 2: 84.4 ± 15.2 kg; NS) nor the body mass index between both groups (group 1: 31.7 ± 5.9 kg/m², vs. group 2: 30.6 ± 5.4 kg/m²; NS). The groups did not differ in TSH, FSH, estradiol, SHBG, prolactin level at the baseline. There was no statistically significant difference between both groups in the cortisol levels at 5 a.m. and 7 a.m. Our study suggests that there is no difference in the morning and 7 p.m. cortisol level between the women with and without PCOS among the population of women with body mass index greater than or equal 25 kg/m².

[The 1691 G > A (factor V Leiden) and 1328 T > C V coagulation factor polymorphisms and recurrent miscarriages]. / Polimorfizmy 1691 G > A (czynnik Leiden) i 1328 T > C genu V czynnika krzepniecia a wystepowanie poronien nawracajacych.

Objectives: Inherited thrombophilia might lead to recurrent pregnancy loss (RPL). The aim of the study was to estimate the prevalence of V coagulation factor polymorphisms related with inherited thrombophilia among women in Malopolska region.Material and methods: Group of 136 women, who experienced at least 2 unexplained, idiopathic pregnancy loss. 106 healthy women having at least one uncomplicated pregnancy and delivered healthy children constituted a control group. Each patient were examined for factor V Leiden (FVL) and mutation 1328 T>C of factor V gene with use of real ­time PCR and Taq-Man probes.Results: Among patients with RPL inhabiting region of Malopolska compared to control group occurred higher prevalence of FVL and mutation 1328 T>C. There is coincidence of polymorphism 1328 T>C of factor V gene and FVL in group of early and late RPL.Conclusions: TC genotype of 1328 T>C mutation carriers reveal tendency toward RPL below 7 weeks of pregnancy.Based on results of these findings inherited thrombophilia evaluation in patients after two or more RPL should be recommended.

[Blood pressure and polycystic ovary syndrome (PCOS)]. / Cisnienie tetnicze krwi a zespól policystycznych jajników (PCOS).

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder occurring in women of childbearing age. The literature describes the relationship between PCOS and high blood pressure levels and increased risk of arterial hypertension development, which is an important and strong risk factor for adverse cardiovascular events in the future. Among the main causes of hypertension in PCOS women insulin resistance, hyperandrogenism, greater sympathetic nerve activity and concomitance of obesity are stressed. Because PCOS may contribute to earlier development of hypertension, as well as pre-hypertension, therefore it is advisable to monitor blood pressure systematically, to control known risk factors, and to initiate the treatment of hypertension when the disease occur.

[Cyclic Cushing's Syndrome - rare or rarely recognized]. / Cykliczny zespól Cushinga - rzadki czy rzadko rozpoznawany?

Cyclic Cushing's syndrome is a type of Cushing's disease which is characterized by alternating periods of increasing and decreasing levels of cortisol in the blood. The diagnostic criteria for cyclic Cushing's syndrome are at least three periods of hypercortisolism alternating with at least two episodes of normal levels of serum cortisol concentration. The epidemiology, signs, symptoms, pathogenesis and treatment of cyclic Cushing's syndrome have been discussed.

[The ovarian origin of hiperandrogenism in the postmenopausal woman the adrenal adenoma--a case report]. / Hiperandrogenemia pochodzenia jajnikowego u kobiety po menopauzie z towarzyszacym gruczolakiem nadnercza--opis przypadku.

Hyperandrogenism is a clinical condition characterized by excessive secretion of male sex hormones. An excess amount of androgens in women is manifested by symptoms of defeminization and masculinization. Hormonally active adrenal and ovarian tumors and non-tumor causes must be considered in the differential diagnosis. The authors describe the case of a 77-year-old patient who had hirsutism and reduction of the timbre of the voice. At the beginning she was suspected to have adrenal hyperandrogenism because of the tumor in the adrenal gland. Then adrenalectomy was conducted but it did not lead to alleviate symptoms. A MRI of the pelvis revealed a change of appendages projection and the patient underwent the total hysterectomy. The normalization of testosterone levels as well as reduction of the symptoms was observed after the operation. Finally, the ovary etiology of hyperandrogenism was confirmed. This case report is an example of difficulties in recognition the etiology of hyperandrogenism.

[The influence of age, place of living, education and number of earlier pregnancies on attendance of pregnant women to screening tests--questionnaire study]. / Wplyw wieku, miejsca zamieszkania, wyksztalcenia i Iiczby wczesniejszych ciaz na zglaszalnosc ciezarnych do badan przesiewowych- badanie ankietowe.

UNLABELLED: The aim of this study was to assess attendance at the screening programme in pregnancy and the influence of age, number of past pregnancies, level of education and place of residence on the attendance. MATERIAL AND METHODS: Our study was performed on the basis of an anonymous questionnaire handed out 543 women aged 16-45, on the third day of their puerperal, in one of the five obstetric wards in southern Poland. The questionnaire contained questions about participation in recommended for pregnant women screening tests such as: fasting blood glucose level measurement, oral glucose tolerance test, blood type test, measurement of hepatitis B surface antigen and antibodies to VDRL, Rubella, Toxoplasma gondii, hepatitis C virus at least once during pregnancy. RESULTS: The highest attendance rate was related with blood type test, whereas the lowest was related with measurement of antibodies to hepatitis C virus (95.6% vs 22.7%, p < 0.001). A very low percentage of pregnant patients measured Rubella antibodies (29.1%). A larger proportion of the respondents checked antibodies against Toxoplasma gondii (41.6%). The attendance at fasting blood glucose level was 66.9 % and at oral glucose tolerance test was 63.7%. The attendance according as age, place of living, number of past pregnancies and level of education was described in detail. CONCLUSION: Despite current recommendations of Polish Gynecological Society and the ordinance of polish Minister of Health the percentage of women participating in screening tests during pregnancy is still insufficient. Age, place of residence and education remain strong factors influencing attendance at the screening programme in pregnancy.

[Changes in blood pressure and heart rate by an increase in serum estradiol in women undergoing controlled ovarian hyperstimulation]. / Zmiany cisnienia tetniczego i czestosci serca pod wplywem wzrostu stezenia estradiolu w surowicy u pacjentek poddanych kontrolowanej stymulacji jajeczkowania.

UNLABELLED: The aim of the study was to evaluate changes in blood pressure and heart rate in women undergoing controlled ovarian stimulation (COH) in preparation for assisted reproduction techniques. Material and method: The comparison of blood pressure and heart rate measurements obtained from 5 women (age 35.3 +/- 9.4 years) was performed. The data were collected during the 24-hour ambulatory blood pressure monitoring (ABPM) using Holcard sphygmomanometer CR-07 Aspel S.A. at the beginning and in the last day of short protocol of COH with the use of triptorelin (Decapeptyl 0.1 mg/day--Ferring GmbH) and the total supply of Gonalu F 225 U/day--Merck Serono) and Menotropiny 75j FSH + LH 75 U/day (Merional Imed/lBSA). RESULTS: During COH the increase in the serum estradiol level was detected (54.03 +/- 9.4 pg/ml at baseline vs. 1128.7 +/- 208.6 pg/ml after COH, p < 0.001). However, there were no differences in SBP and DBP values before stimulation and on the day of its completion. Only the decrease of mean arterial pressure measured by oscillometric method was observed during the study (95.1 +/- 25.3 mmHg vs. 87.6 +/- 27.8 mmHg, p<0.02). Mean arterial pressure measured by oscillometric method decreased in the daytime measurements (98 +/- 27.3 mmHg vs. 92.8 +/- 26.5 mmHg, p<0.05) as well as in the nighttime measurements (84.4 +/- 17.4 mmHg vs. 78.8 +/- 14, 4 mmHg, p <0.05). After COH, the higher heart rate (HR) was measured (in overall ABPM statistics: baseline HR 68.5 +/- 12.8/min vs. 73.6 +/- 13.7/ min after COH, p<0.002 and also in daytime statistics: baseline HR70.8 +/- 13.6 / min vs. 76.3 +/- 15.5 / min after COH, p<0.002). CONCLUSIONS: The increase in serum estradiol level caused by COH leads to increase in heart rate and reduction in mean arterial pressure measured by oscillometric method. However, short-term increase in serum estradiol during COH is not associated with significant changes in systolic and diastolic blood pressure in women preparing for the in vitro procedure.

Evening not morning plasma cortisol level is higher in women with polycystic ovary syndrome.

INTRODUCTION: The aim of our study was to assess the morning and evening cortisol plasma levels in women with polycystic ovary syndrome (PCOS). MATERIAL AND METHOD: 95 patients gave their informed consent to participate in the study and were divided into 2 groups. Group A consisted of 40 PCOS patients and group B consisted of 55 women without features of PCOS. Between day 5 and 8 of the menstrual cycle, morning (7 am), fasting blood samples were taken for the assessment of luteinizng hormone (LH), follicle stimulating hormone (FSH), estradiol, cortisol, prolactin, thyreotropin (TSH), testosterone and dehydroepeiandrosterone (DHEAS). Evening (5 pm) blood samples were also taken for the evaluation of plasma cortisol level RESULTS: There were no differences in mean age, body mass index (BMI), FSH, SHBG, PRL, estradiol and TSH levels between group A and group B. Mean plasma LH level was higher in group A compared to group B (10.7 ± 6.8 IU/l vs 6.6 ± 4.5 LU/l, p < 0.02). Mean plasma testosterone and DHEAS levels were also higher in PCOS patients (3.8 ± 0.6 nmol/l vs 1.63 ± 0.6 nmol/l; 427.7 ± 162.9 vs 236.6 ± 97.8 respectively, p < 0.001). Mean evening plasma cortisol level was higher in PCOS patients (11.8 ± 4.1 ug/dl vs 4.7 ± 1.3 ug/dl, p < 0.02). Mean morning plasma cortisol levels did not differ between groups. CONCLUSION: PCOS women showed the increased evening plasma cortisol level with impacted diurnal secretion rate.

[Metformin and changes in blood pressure and heart rate in lean patients with polycystic ovary syndrome (PCOS)--preliminary study]. / Metformina, a zmiany cisnienia tetniczego krwi i czestosci akcji serca u szczuplych pacjentek z zespolem policystycznych jajników (PCOS)--doniesienie wstepne.

INTRODUCTION: The aim of our study was to assess the value of blood pressure and heart rate using the 24-hour blood pressure monitoring (ABPM) before and after treatment with metformin to patients with polycystic ovary syndrome (PCOS) and normal lean. MATERIAL AND METHODS: 5 patients received metformin 1500 mg per day in three divided doses. ABPM was performed to each patient with PCOS twice: before and after 6 months of treatment with metformin. RESULTS: In patients with PCOS and normal lean after treatment with metformin we observed: statistically significant lower systolic blood pressure (120.2 ± 22.33 mmHg vs 113.22 ± 21.43 mm Hg, p = 0.0248); lower systolic blood pressure of daily measurements (127.1 ± 32.13 mmHg vs 116.1 ± 22.08 mmHg, p = 0.0062); reduction in average arterial pressure MAP in the measurement of the day (95.52 ± 22.76 mmHg vs 88.36 ± 16.41 mmHg, p = 0.048); oscillometric pressure reduction (96.27 ± 27.93 mmHg vs 87.82 ± 21.61, p = 0.0004 mmHg); oscillometric pressure reduction of daily measurements (102.1 ± 27.93 mmHg vs 91.85 ± 21.61 mmHg, p = 0.0032); oscillometric pressure reduction in the measure- ment of the night (88.81 ± 24.85 mmHg vs 82.22 ± 20.54 mmHg, p = 0.0089). In women after treatment with metformin has also been observed higher average heart rate (65.82 ± 13.48 / min vs. 70.71 ± 16.04 min; p < 0.01). The calculations included 500 measurements. CONCLUSION: Treatment with metformin in patients with PCOS and normal lean leads to lower blood pressure and increases the frequency of heart rate.