Elsevier

Contraception

Volume 52, Issue 3, September 1995, Pages 143-149
Contraception

Original research article
Relationships between blood pressure, oral contraceptive use and metabolic risk markers for cardiovascular disease

https://doi.org/10.1016/0010-7824(95)00153-2Get rights and content

Abstract

Data from a previous study, designed to compare metabolic risk markers for cardiovascular disease in non-users and oral contraceptive (OC) users, were analysed to evaluate the influence of OC composition on blood pressure. Healthy, female volunteers (1189 women) either not using OC (non-users) or currently using one of six different combined formulations (users) were compared. Combinations studied contained 30–40 μg ethinyl estradiol combined with the progestins levonorgestrel, norethindrone (at two and three different doses, respectively) or desogestrel. After statistical standardisation to account for the significantly greater age of the non-users and longer duration of OC use amongst the levonorgestrel combination users, mean blood pressure was higher, compared with non-users, in users of monophasic or triphasic levonorgestrel combinations (systolic: +4.3 mmHg (p < 0.001) and +2.7 mmHg (p < 0.001), respectively; diastolic: +2.6 mmHg (p < 0.001) and +2.3 mmHg (p < 0.05), respectively). Blood pressures in users of monophasic norethindrone and desogestrel combinations were not significantly raised and there was no increase in the proportion of women with abnormal values. Diastolic and systolic blood pressures were positively associated with oral glucose tolerance test insulin response (r = 0.11 (p < 0.01) and r = 0.15 (p < 0.001), respectively) in users but not in non-users. Currently used OC containing norethindrone or desogestrel progestins have little impact on blood pressure. Their correlated reduction in impact on insulin concentrations, though small, suggests common mechanisms through which OC affect blood pressure and insulin.

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      Studies conducted performing office BP measurements have shown that preparations containing higher (≥ 50 μg) doses of ethinyl-estradiol (EE) may increase BP up to 15 mmHg [1,2]. Increases of about 4–5 mmHg BP have been documented with COCs containing lower EE doses [3–5] and confirmed by the few data performed with ambulatory 24-h BP monitoring [6,7]. Even the administration of EE-based hormonal contraceptive with vaginal ring induces an increase of 24-h BP of about 2 mmHg [8].

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      Values of nighttime heart rate remained unmodified (Fig. 2). Most studies have shown that, in nonhypertensive women, the administration of OCs increases BP [10–16]. These results are reinforced by data performed with a 24-h ambulatory monitoring [26,27].

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      For this reason, OCs are contraindicated in women with hypertension [8,9]. In nonhypertensive women, OCs with high (50 mcg or more) [6,7], but also with low, EE dose may elevate office blood pressure [8–15], although inconsistently [16–18]. Furthermore, in the few studies performed with 24-h ambulatory monitoring, an increase in blood pressure has been consistently reported during OC use [19–21].

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