Malignant hypertension associated with use of oral contraceptives.

Abstract

A 26-year-old woman who had been taking an oral contraceptive preparation for two years Zacherle and Richardson (I972) described a case in which severe hypertension developed while the patient was on oral contraceptives. Antihypertensive agents controlled the blood pressure satisfactorily and the blood pressure remained normal after withdrawal of all therapy. Reintroduction of a sequential oral contraceptive agent 3 years later again resulted in severe hypertension associated on this occasion with early hypertensive retinopathy and irreversible renal failure. Harris (I969) described a case of malignant hypertension associated with oral contraceptive therapy. The patient had never been pregnant nor was there a family history of hypertension. After one year on antihypertensive therapy, the patient developed symptoms of postural hypotension. Therapy was discontinued and the patient's blood pressure subsequently remained normal. So far as we are aware, there have been no other reports showing an association between malignant hypertension and oral contraceptive agents.Case report A 26-year-old woman presented in June I966 with an 8-month history of increasing dyspnoea, a 3-month history of headaches, and two episodes of vomiting in the preceding week. During her second pregnancy in I960 she had developed hypertension, but her blood pressure had settled to normal levels post partum, and investigation had failed to reveal a cause for her hypertension. In I964, the patient had been started on the oral contraceptive agent 'Anovlar 2I' (norethisterone acetate 4 mg and ethinyl oestradiol o.os mg) by her general practitioner. She remained on this therapy until the time of admission when her blood pressure was 230/I50 mmHg (3I/20 kPa). Fundi showed papilloedema, haemorrhages, exudates, and hypertensive vessel changes. She was moderately obese.Blood urea was 33 mg/Ioo ml (5 mmol/l). Plasma sodium was I36 mmol/l. and chloride was 103 mmol/l. Plasma potassium on admission was low, being 2.7 mmol/l, but repeat estimations were normal at 3.9 mmol/l and 4.2 mmol/l. Creatinine clearance was 70 ml/min. There was proteinuria, but mid-stream specimens of urine contained no cells or casts and there

Past oral contraceptive use and self-reported high blood pressure in postmenopausal women

“…Studies have repeatedly reported increases in blood pressure with current hormonal contraception use [ 4 , 6 , 13 - 15 ]. These studies also demonstrated that this effect quickly diminishes once hormonal contraception is stopped [ 6 , 13 , 15 , 16 ]. Very few studies have focused on past hormonal contraception use and risk of subsequent high blood pressure.…”

Rapid non‐genomic activation of cytosolic cyclic AMP‐dependent protein kinase activity and [Ca2+]i by 17β‐oestradiol in female rat distal colon

“…Alterations in colonic salt and water transport can have important implications for total body water and electrolyte balance. There is a dramatic increase in plasma oestrogen concentrations during gestation (Preedy & Aitken, 1961; Roy & Mackay, 1962) – and in other high oestrogen states such as certain phases of the menstrual cycle (Thorn & Engel, 1938), and during use of the combined oral contraceptive pill – and this has been associated with salt and water retention resulting in oedema and hypertension (Katz & Kappas, 1967; Dunn et al ., 1975; Laragh, 1976; Fisch & Frank, 1977). Previous studies from our laboratory have demonstrated a down‐regulation of net chloride secretion and an up‐regulation of sodium reabsorption following addition of 17β‐oestradiol in human distal colon (McNamara et al ., 1995; 1997).…”

Malignant Hypertension in Association with Low Estrogen Dose Oral Contraceptives: Case Report and Review of Literature

“…Dunn et al presented a case of a young lady with a history of hypertension and being overweight who developed MH after taking oral contraceptive preparations for two years. Control of her BP was obtained by the withdrawal of the oral contraceptive agent and antihypertensive therapy [ 8 ]. Weir et al found the increase in systolic blood pressure to be the same in women taking either low-dose or high-dose estrogen oral contraceptive preparations [ 4 ].…”