Blood Hypertension

Short-term studies have been suggested that combined hormonal contraceptives may induce a mild rise in blood pressure ^(95,96,97). In fact, it seems that HCs induce hypertension in approximately 5% of users of high-dose pill that contains at least 50 μg estrogen and 1 to 4 mg progestin, however small increases in blood pressure have been reported even among users of modern low-dose formulations ^(7,97).

In fact, it seems that low-dose pill users have a 1.0 mm Hg rise in diastolic pressure, which is statistically significant but clinically unimportant ⁽⁹⁹⁾. In addition, blood pressure differences between HC users and non users tend to increase with age.

Furthermore, obesity,family history of hypertension and previous hypertensive disorders of pregnancy seem associated with an increase of blood pressure during hormonal contraceptive use ^(9,100). It is very likely that blood pressure undergoes physiologic variation depending on hormonal fluctuations ^(96,101,102).

Data on long- term and withdrawal effects of HC use on this outcome are, however, scarce. A recent prospective cohort study carried out on HC-users and past users aged 28-75 years, showed that hormonal contraceptives increase blood pressure, and urinary albumin excretion (UAE) and may be deleterious on urinary function in 6.3% of the users. Although stopping may result in correction of these effects.In fact, women who take HCs have an increased risk of developing new hypertension, which returns to baseline within 1 to 3 months of HC cessation ⁽¹⁰³⁾. Therefore, some cases of irreversible hypertension, kidney failure and malignant nephrosclerosis have been reported ^(104,105).

Women with pre-existing hypertension who take HCs have an increased risk of stroke and myocardial infarction when compared with hypertensive women who do not ^(8,61,106). Women who smoke, have an increased risk of hypertension (2 to 3 times) when take HCs. Smoking increases the risk of vascular damage by increasing sympathetic tone, platelet stickness and reactivity, free radical production, damage of endothelium, and by surges in arterial pressure.
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Surprisingly, this increased risk declines on quitting cigarettes within 2 to 3 months ⁽¹⁰⁷⁾. Blood pressure elevations are usually attributed to the estrogen, but there is evidence of a progestin role as well ^(102,103) The mechanism by which some HCs users develop hypertension is poorly understood,but it may be related to changes in the renin-angiotensin-aldosterone system ^(108,109) The raise of hypertension often associated with raise of weight is the consequence of increased fluid retention in women taking hormonal contraceptives, especially if over 35 years. Androgenic progestins accentuate sodium retention, which may play an important role .