Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations

Abstract

Oral contraceptive pills (OCPs) have been used as effective and popular forms of contraception since the middle of the last century. By 2019, over 150 million reproductive-aged individuals were using OCPs to prevent unintended pregnancies worldwide. Safety concerns regarding the effects of OCPs on blood pressure were reported soon after these pills gained approval. Although OCP doses were subsequently reduced, epidemiologic evidence continued to support a smaller, but significant association between OCPs and hypertension. Given the rising prevalence of hypertension, as well as the adverse effects of cumulative exposure to blood pressure elevations on cardiovascular disease risk, understanding the nature of the association between OCPs and hypertension is important for clinicians and patients to assess the risks and benefits of use, and make individualized decisions regarding contraception. Therefore, this review summarizes the current and historical evidence describing the association between OCP use and blood pressure elevations. Specifically, it identifies the pathophysiologic mechanisms linking OCPs to hypertension risk, describes the magnitude of the association between OCPs and blood pressure elevations, and distinguishes the effects of various OCP types on blood pressure. Finally, it describes current recommendations regarding hypertension and OCP use, as well as identifies strategies, such as over-the-counter OCP prescribing, to safely and equitably improve access to oral contraception.

The effect of Hormonal Contraceptives in Health Status of Sudanese Women in Omdurman Locality-Sudan

“…Regarding to Hypertension oral contraceptives frequently causes a mild elevation in blood pressure within the normal range; however, overt hypertension can occur [13].…”

Hipertensión a través del ciclo de vida de la mujer: ¿qué factores influyen?

“…The increase in BP is related to a rise in hepatic production of angiotensinogen, activation of the RAAS, an increase in vascular resistance, and a decrease in circulating nitric oxide (NO). 2,6…”

Resistant hypertension

“…Available epidemiological studies of high dose estrogen use found a mean elevation in BP of 3 to 6 mmHg, and cessation of estrogen use typically led to return of BP to baseline ranges [10,11]. Lower estrogen doses, however, as seen in postmenopausal hormone therapy, have revealed a much lower association with HTN [12].…”

“…Although, a disproportionately higher rate of RH in the African American population has been suggested to have a genetic predisposition and associated with a particular CYP3A5 enzyme (11β-hydroxysteroid dehydrogenase type 2), which plays a role in metabolism of cortisol, particularly in the kidney [11].…”