Oral Contraceptives and Hypertension

Abstract & Commentary

Synopsis: The use of oral contraceptives in women with hypertension produced higher blood pressures and poor control of blood pressure.

Source: Lubianca JN, et al. Contraception. 2003;67: 19-24.

Lubianca and associates from Porto Alegre, Brazil, reviewed the experience of 171 women attending a clinic for the treatment of hypertension. Users of oral contraceptives had higher diastolic blood pressures (an average of 7 mm higher), and a greater prevalence of significant hypertension reflected inadequate control. There were a higher number of women with moderate-to-severe hypertension among the oral contraceptive users.

Comment by Leon Speroff, MD

The standard of treatment for many years has been to support the use of oral contraceptives in women younger than 35 years of age with hypertension well controlled by medication, as long as they are otherwise healthy and do not smoke. Of course, the lowest dose estrogen formulations are recommended. This has been a judgment based upon the argument that careful monitoring and treatment of the blood pressure would maintain pressures below 140/90 and allow continuation of oral contraceptive usage. The problem is a lack of data in such patients.

There are important unanswered questions. How does the use of oral contraceptives influence of the efficacy and stability of antihypertensive treatment? Do women with controlled hypertension who use oral contraceptives have a greater risk of cardiovascular events?

This study is limited by its cross-sectional nature, but it does suggest that oral contraceptive use has a negative effect on blood pressure control in hypertensive patients. I have heard of a case-control study, not yet published, indicting a higher risk of myocardial infarction and stroke in women with controlled hypertension who use oral contraceptives. Therefore, there is reason for increasing concern with these patients.

Certainly, a woman with controlled hypertension who has additional medical problems or who smokes should not use oral contraceptives. At this point in time, the data are insufficient to categorically ban the use of oral contraceptives in young women with controlled hypertension who are otherwise healthy. However, very frequent and close monitoring of the blood pressure is essential. An adverse effect on the medical control, the hypertension is an urgent message to use another contraceptive method. Myocardial infarction and stroke rarely occur before the age of 35, and for this reason 35 is an accepted cutoff age limit for oral contraceptive use in women with risk factors for cardiovascular disease.

Dr. Speroff is Professor of Obstetrics and Gynecology Oregon Health Sciences University, Portland, Ore.