Hormonal Contraception in Women With Hypertension
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Hypertension, defined as systolic blood pressure (SBP) of at least 130 mm Hg or diastolic blood pressure (DBP) of at least 80 mm Hg, is a major risk factor for cardiovascular disease (CVD). Selecting the appropriate hormonal contraception in women with hypertension is important because several of these contraceptives increase BP and, in those with established hypertension, increase the risk for stroke and myocardial infarction. This insight provides guidance in selecting hormonal contraception given that hypertension can be either a relative or absolute contraindication.

Guidelines for Treatment
The approach to selecting which hormonal contraception to use in women with hypertension includes measurement of BP, assessment of risk factors, and consideration of age and degree of hypertension. The US Medical Eligibility Criteria for Contraceptive Use provides the most comprehensive recommendations for women with underlying medical conditions. For CHC, these recommendations do not differentiate between progestin type, include only Ethinyl estradiol doses less than or equal to 35 ?g, and combine transdermal preparations and the vaginal ring. The various POC forms are assessed separately, but the progestin types are grouped together. For hypertension, recommendations are based on the assumption that no other CVD risk factors exist and on previous BP guidelines. Therefore, they do not provide recommendations for the updated stage I hypertension.

In 2019, the American College of Obstetricians and Gynecologists published a Practice Bulletin that included the updated BP guidelines, but they continue to endorse US Medical Eligibility Criteria given the need for research in the newly defined stage I hypertension. In women with hypertension, frequent monitoring of BP is important after the initiation of CHC, and use of CHC should be stopped if BP increases. Changes to BP are reversible and may return to pretreatment levels within 3 months of discontinuation.

Hypertension is a modifiable risk factor for CVD. For women with hypertension, certain hormonal contraception increases the risk of stroke and myocardial infarction. Choosing the appropriate type of hormonal contraception for women with hypertension is based on age and degree of hypertension. POCs are generally safe in women with hypertension, but COCs should be prescribed carefully and to women aged 35 years and younger. Research is needed to understand how the updated guidelines for BP might change hormonal contraception management given the new definition of stage I hypertension and how different antihypertensives may affect the CVD risk of hormonal contraceptives. In addition, further studies are needed to understand the safety profiles of the nonoral hormonal preparations and ultra-low-dose (ie, 10 µg ethinyl estradiol) hormonal contraception in women with hypertension.
Source: https://jamanetwork.com/journals/jama/fullarticle/2771023?guestAccessKey=076075ca-93f9-44fe-b9ff-856fea427350&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm;_c
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