Skip to main content
SpringerLink
Log in

Contraception Use in Women with Hypertension

  • Chapter
  • First Online:
Contraception for the Medically Challenging Patient

  • 1033 Accesses

Abstract

Hypertension is among the most common conditions that affect women of reproductive age. It is also a common complication of pregnancy, and should be treated in pregnant women with blood pressures ≥160/110. For blood pressures 140–159/90–109, no clear data exist to demonstrate benefits of treatment. When treatment is indicated, labetalol and methyldopa are first-line agents.

Most women, with or without hypertension, will not have an adverse effect on blood pressure from any form of contraception. Progestin-only methods, including the pill, injection, subdermal implant, and intrauterine device, are safe in women with hypertension, even if blood pressure is poorly controlled. Estrogen-containing methods, including the pill, patch, and ring, have all been shown to increase blood pressure, although the degree of increase has not been well established in the literature. In women with hypertension using these methods, data show an increased risk of both stroke and myocardial infarction, compared to women without hypertension. For these reasons, all women should have their blood pressure measured prior to initiation of estrogen-containing contraceptives. These methods are graded as category 4 (method poses an unacceptable health risk) in women with blood pressures ≥160/100. Because of data demonstrating a dose-dependent risk of cardiovascular events in women using contraceptives containing estrogen, when these methods are selected, doses ≤35 μg are universally preferred.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Centers for Disease Control and Prevention. Vital signs: prevalence, treatment, and control of hypertension – United States, 1999–2002 and 2005–2008. MMWR. 2011;60(4):103–8. PubMed PMID: 21293325.

    Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72. PubMed PMID: 12748199.

    Article  CAS  PubMed  Google Scholar 

  3. Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure control and cardiovascular risk factors in Americans with diagnosed hypertension. Hypertension. 2008;51(4):1142–8. PubMed PMID: 18259031.

    Article  CAS  PubMed  Google Scholar 

  4. Egan BM, Zhao YM, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303(20):2043–50. PubMed PMID: WOS:000278018200028. English.

    Article  CAS  PubMed  Google Scholar 

  5. Bateman BT, Shaw KM, Kuklina EV, Callaghan WM, Seely EW, Hernandez-Diaz S. Hypertension in women of reproductive age in the United States: NHANES 1999–2008. PLoS One. 2012;7(4):e36171. PubMed PMID: 22558371. Pubmed Central PMCID: 3340351.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Schwarz EB, Postlethwaite DA, Hung YY, Armstrong MA. Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women. Ann Intern Med. 2007;147(6):370–6. PubMed PMID: 17876020. Pubmed Central PMCID: 2941151.

    Article  PubMed Central  PubMed  Google Scholar 

  7. American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31. PubMed PMID: 24150027.

    Article  Google Scholar 

  8. Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med. 2005;165(8):923–8. PubMed PMID: 15851645.

    Article  PubMed  Google Scholar 

  9. Reiter L, Brown MA, Whitworth JA. Hypertension in pregnancy: the incidence of underlying renal disease and essential hypertension. Am J Kidney Dis. 1994;24(6):883–7. PubMed PMID: 7985664.

    Article  CAS  PubMed  Google Scholar 

  10. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404–23. PubMed PMID: 21388771. Pubmed Central PMCID: 3124072.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension. 2008;51(4):1002–9. PubMed PMID: 18259010.

    Article  CAS  PubMed  Google Scholar 

  12. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol. 2002;100(2):369–77. PubMed PMID: 12151166.

    Article  PubMed  Google Scholar 

  13. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ (Clin Res Ed). 2007;335(7627):974. PubMed PMID: 17975258. Pubmed Central PMCID: 2072042.

    Article  Google Scholar 

  14. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;1, CD002252. PubMed PMID: 17253478.

    PubMed  Google Scholar 

  15. von Dadelszen P, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet. 2000;355(9198):87–92. PubMed PMID: 10675164.

    Article  Google Scholar 

  16. Seely EW, Ecker J. Clinical practice. Chronic hypertension in pregnancy. N Engl J Med. 2011;365(5):439–46. PubMed PMID: 21812673.

    Article  CAS  PubMed  Google Scholar 

  17. Aleksandrov NA, Fraser W, Audibert F. Diagnosis, management, and evaluation of hypertensive disorders of pregnancy. J Obstet Gynaecol Can. 2008;30(11):1000. Author reply – 1. PubMed PMID: 19126280.

    PubMed  Google Scholar 

  18. Horvath JS, Phippard A, Korda A, Henderson-Smart DJ, Child A, Tiller DJ. Clonidine hydrochloride – a safe and effective antihypertensive agent in pregnancy. Obstet Gynecol. 1985;66(5):634–8. PubMed PMID: 3903581.

    CAS  PubMed  Google Scholar 

  19. Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ (Clin Res Ed). 2003;327(7421):955–60. PubMed PMID: 14576246. Pubmed Central PMCID: 259162.

    Article  CAS  Google Scholar 

  20. Laragh JH, Sealey JE, Ledingha JG, Newton MA. Oral contraceptives – renin aldosterone and high blood pressure. JAMA. 1967;201(12):918. PubMed PMID: WOS:A19679882400003. English.

    Article  CAS  PubMed  Google Scholar 

  21. August P. Hypertension in women. Adv Chronic Kidney D. 2013;20(5):396–401. PubMed PMID: WOS:000324445200005. English.

    Article  Google Scholar 

  22. Cardoso F, Polonia J, Santos A, Silva-Carvalho J, Ferreira-de-Almeida J. Low-dose oral contraceptives and 24-hour ambulatory blood pressure. Int J Gynecol Obstet. 1997;59(3):237–43. PubMed PMID: WOS:000071653600008. English.

    Article  CAS  Google Scholar 

  23. Heintz B, Schmauder C, Witte K, Breuer I, Baltzer K, Sieberth HG, et al. Blood pressure rhythm and endocrine functions in normotensive women on oral contraceptives. J Hypertens. 1996;14(3):333–9. PubMed PMID: WOS:A1996UJ80600010. English.

    Article  CAS  PubMed  Google Scholar 

  24. Lubianca JN, Faccin CS, Fuchs FD. Oral contraceptives: a risk factor for uncontrolled blood pressure among hypertensive women. Contraception. 2003;67(1):19–24. PubMed PMID: WOS:000180496200004. English.

    Article  CAS  PubMed  Google Scholar 

  25. Chasan-Taber L, Willett WC, Manson JE, Spiegelman D, Hunter DJ, Curhan G, et al. Prospective study of oral contraceptives and hypertension among women in the United States. Circulation. 1996;94(3):483–9. PubMed PMID: WOS:A1996UZ05100038. English.

    Article  CAS  PubMed  Google Scholar 

  26. Farley TM, Collins J, Schlesselman JJ. Hormonal contraception and risk of cardiovascular disease. An international perspective. Contraception. 1998;57(3):211–30. PubMed PMID: 9617537.

    Article  CAS  PubMed  Google Scholar 

  27. Croft P, Hannaford PC. Risk-factors for acute myocardial-infarction in women – evidence from the Royal College of General Practitioners Oral Contraception Study. BMJ. 1989;298(6667):165–8. PubMed PMID: WOS:A1989R926400028. English.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Poulter NR, Chang CL, Farley TMM, Kelaghan J, Meirlk O, Marmot MG, et al. Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case–control study. Lancet. 1997;349(9060):1202–9. PubMed PMID: WOS:A1997WW71700009. English.

    Article  Google Scholar 

  29. Curtis KM, Mohllajee AP, Martins SL, Peterson HB. Combined oral contraceptive use among women with hypertension: a systematic review. Contraception. 2006;73(2):179–88. PubMed PMID: WOS:000235252500008. English.

    Article  CAS  PubMed  Google Scholar 

  30. Van Den Bosch MAAJ, Kemmeren JM, Tanis BC, Mali WPTM, Helmerhorst FM, Rosendaal FR, et al. The RATIO study: oral contraceptives and the risk of peripheral arterial disease in young women. J Thromb Haemost. 2003;1(3):439–44. PubMed PMID: WOS:000183061900011. English.

    Article  Google Scholar 

  31. Lidegaard O, Kreiner S. Contraceptives and cerebral thrombosis: a five-year national case–control study. Contraception. 2002;65(3):197–205. PubMed PMID: WOS:000174908400002. English.

    Article  CAS  PubMed  Google Scholar 

  32. Schwartz SM, Petitti DB, Siscovick DS, Longstreth WT, Sidney S, Raghunathan TE, et al. Stroke and use of low-dose oral contraceptives in young women – a pooled analysis of two US studies. Stroke. 1998;29(11):2277–84. PubMed PMID: WOS:000076754100006. English.

    Article  CAS  PubMed  Google Scholar 

  33. WHO. Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case–control study WHO collaborative study of cardiovascular disease and steroid hormone contraception. Lancet. 1996;348(9026):498–505. PubMed PMID: 8757151.

    Article  Google Scholar 

  34. Heinemann LA, Lewis MA, Spitzer WO, Thorogood M, Guggenmoos-Holzmann I, Bruppacher R. Thromboembolic stroke in young women. A European case–control study on oral contraceptives. Transnational research group on oral contraceptives and the health of young women. Contraception. 1998;57(1):29–37. PubMed PMID: 9554248.

    Article  CAS  PubMed  Google Scholar 

  35. Gillum LA, Mamidipudi SK, Johnston SC. Ischemic stroke risk with oral contraceptives: a meta-analysis. JAMA. 2000;284(1):72–8. PubMed PMID: 10872016.

    Article  CAS  PubMed  Google Scholar 

  36. Petitti DB. Hormonal contraceptives and arterial thrombosis – not risk-free but safe enough. N Engl J Med. 2012;366(24):2316–8. PubMed PMID: 22694003.

    Article  CAS  PubMed  Google Scholar 

  37. Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366(24):2257–66. PubMed PMID: 22693997.

    Article  CAS  PubMed  Google Scholar 

  38. Division of Reproductive Health NCfCDP, Health Promotion CfDC, Prevention. U.S. selected practice recommendations for contraceptive use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edn. MMWR. 2013;62(RR-05):1–60. PubMed PMID: 23784109.

    Google Scholar 

  39. Timmer CJ, Mulders TM. Pharmacokinetics of etonogestrel and ethinylestradiol released from a combined contraceptive vaginal ring. Clin Pharmacokinet. 2000;39(3):233–42. PubMed PMID: 11020137.

    Article  CAS  PubMed  Google Scholar 

  40. Devineni D, Skee D, Vaccaro N, Massarella J, Janssens L, LaGuardia KD, et al. Pharmacokinetics and pharmacodynamics of a transdermal contraceptive patch and an oral contraceptive. J Clin Pharmacol. 2007;47(4):497–509. PubMed PMID: 17389559.

    Article  CAS  PubMed  Google Scholar 

  41. Minshall RD, Pavcnik D, Browne DL, Hermsmeyer K. Nongenomic vasodilator action of progesterone on primate coronary arteries. J Appl Physiol (1985). 2002;92(2):701–8. PubMed PMID: 11796684.

    CAS  Google Scholar 

  42. Hussain SF. Progestogen-only pills and high blood pressure: is there an association? A literature review. Contraception. 2004;69(2):89–97. PubMed PMID: 14759612.

    Article  CAS  PubMed  Google Scholar 

  43. Hall WD, Douglas MB, Blumenstein BA, Hatcher RA. Blood pressure and oral progestational agents. A prospective study of 119 black women. Am J Obstet Gynecol. 1980;136(3):344–8.

    CAS  PubMed  Google Scholar 

  44. Spellacy WN, Birk SA. The effect of intrauterine devices, oral contraceptives, estrogens, and progestogens on blood pressure. Am J Obstet Gynecol. 1972;112(7):912–9. PubMed PMID: 4114467.

    CAS  PubMed  Google Scholar 

  45. Wilson ES, Cruickshank J, McMaster M, Weir RJ. A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen. Br J Obstet Gynecol. 1984;91(12):1254–60. PubMed PMID: 6440589.

    Article  CAS  Google Scholar 

  46. WHO. Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case–control study. World Health Organization collaborative study of cardiovascular disease and steroid hormone contraception. Contraception. 1998;57(5):315–24. PubMed PMID: 9673838.

    Article  Google Scholar 

  47. Frederiksen MC. Depot medroxyprogesterone acetate contraception in women with medical problems. J Reprod Med. 1996;41(5 Suppl):414–8. PubMed PMID: 8725704.

    CAS  PubMed  Google Scholar 

  48. White WB, Pitt B, Preston RA, Hanes V. Antihypertensive effects of drospirenone with 17beta-estradiol, a novel hormone treatment in postmenopausal women with stage 1 hypertension. Circulation. 2005;112(13):1979–84. PubMed PMID: 16186434.

    Article  CAS  PubMed  Google Scholar 

  49. Oelkers W, Foidart JM, Dombrovicz N, Welter A, Heithecker R. Effects of a new oral contraceptive containing an antimineralocorticoid progestogen, drospirenone, on the renin-aldosterone system, body weight, blood pressure, glucose tolerance, and lipid metabolism. J Clin Endocrinol Metab. 1995;80(6):1816–21. PubMed PMID: 7775629.

    CAS  PubMed  Google Scholar 

  50. Cagnacci A, Ferrari S, Napolitano A, Piacenti I, Arangino S, Volpe A. Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study. Contraception. 2013;88(3):413–7. PubMed PMID: 23312932.

    Article  CAS  PubMed  Google Scholar 

  51. Stegeman BH, de Bastos M, Rosendaal FR, van HylckamaVlieg A, Helmerhorst FM, Stijnen T, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ (Clin Res Ed). 2013;347:f5298. PubMed PMID: 24030561. Pubmed Central PMCID: 3771677.

    Google Scholar 

  52. Lidegaard O, Nielsen LH, Skovlund CW, Skjeldestad FE, Lokkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001–9. BMJ (Clin Res Ed). 2011;343:d6423. PubMed PMID: 22027398. Pubmed Central PMCID: 3202015.

    Article  Google Scholar 

  53. Dinger JC, Heinemann LA, Kuhl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation. Contraception. 2007;75(5):344–54. PubMed PMID: 17434015.

    Article  CAS  PubMed  Google Scholar 

  54. Tepper NK, Curtis KM, Steenland MW, Marchbanks PA. Blood pressure measurement prior to initiating hormonal contraception: a systematic review. Contraception. 2013;87(5):631–8. PubMed PMID: 23063336.

    Article  PubMed  Google Scholar 

  55. Reeves RA. The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. JAMA. 1995;273(15):1211–8.

    Article  CAS  PubMed  Google Scholar 

  56. Muldoon MF, Nazzaro P, Sutton-Tyrrell K, Manuck SB. White-coat hypertension and carotid artery atherosclerosis: a matching study. Arch Intern Med. 2000;160(10):1507–12. PubMed PMID: 10826466.

    Article  CAS  PubMed  Google Scholar 

  57. Steenland MW, Zapata LB, Brahmi D, Marchbanks PA, Curtis KM. Appropriate follow up to detect potential adverse events after initiation of select contraceptive methods: a systematic review. Contraception. 2013;87(5):611–24. PubMed PMID: 23177264.

    Article  PubMed  Google Scholar 

  58. Shapiro S, Traiger GL, Turner M, McGoon MD, Wason P, Barst RJ. Sex differences in the diagnosis, treatment, and outcome of patients with pulmonary arterial hypertension enrolled in the registry to evaluate early and long-term pulmonary arterial hypertension disease management. Chest. 2012;141(2):363–73. PubMed PMID: 21757572.

    Article  PubMed  Google Scholar 

  59. Pugh ME, Hemnes AR. Pulmonary hypertension in women. Expert Rev Cardiovasc Ther. 2010;8(11):1549–58. PubMed PMID: 21090930. Pubmed Central PMCID: 3077035.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Thorne S, Nelson-Piercy C, MacGregor A, Gibbs S, Crowhurst J, Panay N, et al. Pregnancy and contraception in heart disease and pulmonary arterial hypertension. J Fam Plann Reprod Health Care. 2006;32(2):75–81. PubMed PMID: 16824295.

    Article  PubMed  Google Scholar 

  61. European Society of G, Association for European Paediatric C, German Society for Gender M, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97. PubMed PMID: 21873418.

    Article  PubMed  Google Scholar 

  62. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31(7):1650–7. PubMed PMID: 9626847.

    Article  CAS  PubMed  Google Scholar 

  63. Venitz J, Zack J, Gillies H, Allard M, Regnault J, Dufton C. Clinical pharmacokinetics and drug–drug interactions of endothelin receptor antagonists in pulmonary arterial hypertension. J Clin Pharmacol. 2012;52(12):1784–805. PubMed PMID: 22205719.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jennifer Corbelli M.D., M.S.

  2. Women’s Health Services Research Unit, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA

    Eleanor Bimla Schwarz M.D., M.S.

Authors
  1. Jennifer Corbelli M.D., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleanor Bimla Schwarz M.D., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer Corbelli M.D., M.S. .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Rebecca H. Allen

  2. Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA

    Carrie A. Cwiak

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Corbelli, J., Schwarz, E.B. (2014). Contraception Use in Women with Hypertension. In: Allen, R., Cwiak, C. (eds) Contraception for the Medically Challenging Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1233-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1233-9_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1232-2

  • Online ISBN: 978-1-4939-1233-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation