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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented, and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations, 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however, for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39, who take OCs, are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension, diabetes, or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age, OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension, peripheral arterial occlusion, mesenteric vascular insufficiency, Budd-Chiari syndrome, and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old, who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.
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PMID:A review: adverse effects of oral contraceptives. 22 69

Estrogen replacement in menopause should be used for specific symptoms such as ovarian failure, hot flushes, vaginal atrophy, atrophy of the vulva, and atrophic urethritis. The dose should be as low as possible to be effective and perscribed for as short as time as possible, since there are possible risks of uterine cancer, breast cancer, increased blood pressure, gallstones, deep vein thrombosis, and thromboembolism. Estrogens should be administered to provide the maximum benefit with the minimum risk involved. Estrogens should not be given to patients with known contraindications such as: suspected breast or uterine cancer; undiagnosed genital bleeding; Dubin-Johnson syndrome; acute hepatic disease; previous or present thromboembolism; or severe thrombophlebitis. Careful evaluation should be made before administering estrogen to women with uterine myomata, hyperlipidemia, hypercholesterolemia, sevare varicose veins, chronic hepatic dysfunction, diabetes mellitus, porphyria, or severe hypertension.
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PMID:Estrogen replacement in the menopause. 39 Apr 56

To compare the effects of 3 different oral contraceptives (OCs) on the renin-angiotensin system, women aged 19-30 were given either .5 mg lynestrenol (Group 1, N = 10), the same plus .05 mg ethinyl estradiol (Group 2, N = 9), or .25 mg d-norgestrel plus .05 mg ethinyl estradiol (Group 3, N = 9) for 2 months. Blood samples were taken on Menstrual Cycle Days 8-10 and 22-25 for 4 months, the 1st and last months serving as control cycles. Plasma renin activity (PRA) and angiotensin 2 (A2) concentration were measured by radioimmunoassay. Blood pressures remained normal in all women throughout the study. Both PRA and A2 increased in the 2nd half of the control cycle in all groups. Once treatment began, no significant changes occurred in Group 1, but both PRA and A2 rose significantly in Groups 2 and 3. The characteristic increases noted during the 2nd half of the control cycle were maintained in all groups. It is concluded that combination-type OCs raise PRA and A2 levels, while progestagen-only OCs do not, which may recommend the latter in the treatment of women with predisposition to high blood pressure.
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PMID:Plasma renin activity and angiotensin II during oral contraception. 61 22

The results of 2 studies to determine the relationship between hormonal contraceptive (h.c.) use, hypertension, and nephritis are reported. 828 women, 16-50 years of age, were divided into 3 groups. 1 group had never used h.c.s., 1 group was presently using h.c.s., and 1 group had used h.c.s. for the last time more than a year prior to the study. Women 26-35 years of age who were using h.c.s. at the time of the study more often developed hypertension than other groups. The h.c. users who developed hypertension more often had a family history of hypertension or diabetes mellitus, more often had diabetes themselves, and more often suffered from preeclampsia or eclampsia during pregnancy. In a second study, ethinyl estradiol, norethisterone acetate, epsilon aminocapronic acid, desoxycorticosterone acetate, and table salt were administered singly or in combinations to 2 groups of rats. In one group, a Goldblatt-type hypertension was induced with a clamp on the nephric artery. No increase in blood pressure was observed in animals which received only an estrogenic or progestagenic agent. Significant increases in blood pressure were observed in animals that were given combinations of estrogenic and progestagenic agents, however. Significantly increased plasma-resin activity was observed in all animals which were given estrogen, while animals receiving desoxycorticosterone acetate showed a highly significant decrease in plasma-renin activity.
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PMID:[Oral contraceptives, hypertension and nephrosclerosis]. 62 80

In Europe, about 1% of the women using oral contraceptives develop hypertension. Predisposing factors seem to be age, hypertension problems in past pregnancies, family history of hypertension, personal histories of kidney disorders, diabetes mellitus or adipositas, or diastolic pressure over 80 mm Hg. An overactive renin-angiotensin-aldosterone system may be an important factor in the etiology of this type of hypertension. Oterh possible factors are: reduced excretion of angiotensin 2, increased sensitivity of the arterioles to substances such as angiotensin 2 and noradrenaline, direct effect of ethinyl estradiol and mestranol on the sodium and water system, cardiovascular changes, disorders in the adrenergic system (e.g., catecholamine metabolism). Blood pressure should be checked before beginning any treatment with oral contraceptives and every 3 months after that. For the purpose of differential diagnosis angiotensin 2 in the plasma and catecholanin and its by-products should be checked (24-hour urine samples). In cases of serious hypertension hormone therapy should be discontinued at once. Primary aldosteronism and renal artery stenosis must be excluded in the differential diagnosis, for although these hypertensive disorders exhibit similar biochemical changes, they should be treated by surgical intervention. Usually hypertension is reversible after cessation of therapy with contraceptive steroids. However, some cases of irreversible hypertention, kidney failure, and malignant nephrosclerosis have been described. Hypertensive somen who wish to use oral contraceptives may, under medical supervision try a modified hormonal contraceptive (minipill without estrogen) or sequential or lower dosages.
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PMID:[Clinical aspects of hypertension under contraceptive steroids]. 79 66

In 53 patients, 24 healthy pregnant women and 29 patients with EPH (edema, proteinuria, hypertension) syndrome, the intravenous phenolsulphonphthalein test was performed between the 32nd and 42 weeks of pregnancy. At the same time, the serum creatinine and estrogen excretion in the 24 hour urine were determined. According to this, normal pregnancy and also pregnancies with one or more symptoms of the EPH syndrome without raised blood pressure do not cause changes of the PSP plasma level. A statistically significant rise in the PSP plasma level is only found with a blood pressure of 140/90 mm Hg, and simultaneously a close correlation to the estrogen excretion in the urine (r = -0.4) and the blood pressure (r = 0.6). Estrogen excretion is reduced with increasing blood pressure (r = -0.75). No correlation could be established between the PSP serum level and the creatinine in the serum.
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PMID:[Investigations of changes in the phenolsulphonphthalein plasma levels in pregnant women with EPH syndrome (author's transl)]. 80 10

Oral contraceptives have been implicated as a causative factor of venous thrombosis and thromboembolism. Compounds containing over 50 mcg of estrogen have developed this complication most frequently. Steroid hormones have a marked influence on liver function. Large doses have caused cholestasis and hepatocellular damage. Disturbances in carbohydrate metabolism have been recorded. Lipid metabolism have also been shown to be disturbed with increased serum levels of triglycerides and low density lipoproteins. A rise in the cholesterol serum level seems to be correlated with the progestogen content of the compound. The ''minipill'' with a small dose of progestogen alone had been effective by alteration of the cervical mucus. The ''one-a-month pill'' is a combination of a long-acting estrogen, quinestrol, and a chorter acting progestogen, qunigestanol acetate. It has not been as acceptable or as effective as combined compounds. The ''morning-after'' pill consists of large doses of stilbestrol. The method has been effective but when de-ethylstilbestrol has been given to a patient already pregnant to prevent an early spontaneous abortion, adenocarcinoma of the cervix or vagina has been reported. Hypertension has been more common with increased duration of pill use. High dosage of progestogens and increasing age of patients have increased the incidence of hypertension. Cerebrovascular disease had also been more frequent among pill users. An increased incidence of gallbladder disease and of gallstones has been shown in pill users. Urinary tract and vaginal infections were reported more often in pill users. Increased sexual activity may have been a factor in this relationship. Resumption of ovualation after discontinuation of oral contraceptives usually follows within 4-6 weeks. In about 1% of patients amenorrhea and anovulation result for 6 months or more. This is often accopanied by galactorrhea. There is evidence that mestranol is demethylated to ethinyl estradiol in the liver. Progesterone seems to interfere with conversion. Therefore ethinyl estradiol is preferred as a compound of the pill. Also the different progestogens used are metabolized in the liver to norethisterone before they exert their biological effects. Several drugs, as ampicillin and barbiturates, have been shown to interfere with the efficacy of oral contraceptives. It is concluded that the overall results have shown oral contraceptives to be an excellent form of contraception with minimal and acceptable side effects and the least metabolic disturbance.
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PMID:Current status of oral contraceptive. 82 61

The use of estrogen during the climacterium is discussed. Estrogen should be used only when objective symptoms of a lack of estrogen can be established. Thrombosis, hypertension, breast cancer, uterine cancer and ruptured blood vessels are contraindications to climacteric estrogen use. Progestagens administered in conjunction with sedatives and diuretics can often relieve climacteric afflictions. Continued administration of estrogen should be avoided; estrogen can be administered with or without gestagens 7-10 days before menstruation or in 21-day periods. General practitioners are qualified to administer estrogen and should give patients regular examinations. There is a risk of developing endometrial cancer under climacteric estrogen treatment. Only women who want and need climacteric estrogen treatment should receive it.
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PMID:[Estrogen treatment only when symptoms are present but complaints should not be neglected]. 86 7

To examine the effects of estrogen on the development of high blood pressure in rats with a genetic predisposition toward hypertension, we administered to rats of the spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) strains 0.05 mg mestranol daily from ages 4 to 13 wks. Control animals of each strain received corn oil placebos. Systolic blood pressure was measured by a microphonic tail-cuff technique twice a week after the rats were 6 wks of age. Estrogen treatment in SHR was associated with a significant reduction in the level of hypertension attained, but estrogen treatment had no effect on blood pressure in WKY. Estrogen prevented normal growth in SHR and WKY, but this effect (reproduced in another group of SHR and WKY by restriction of food intake) was not related to the lower blood pressures seen in estrogen-treated SHR. Thus, it appeared that estrogen administration attenuated the rise in blood pressure normally seen in SHR and that this attenuation was independent of the estrogenic effect on body weight.
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PMID:Estrogen attenuation of the development of hypertension in spontaneously hypertensive rats. 91 Sep 25

In this review, the clinical reality, the statistical risk, and the frequency of thromboembolism in pill users are evaluated, 6 cases described, and premonitory signs, treatment, and etiology are discussed. Clinically these thromboembolisms appear in unlikely subjects and unusual bodily locations such as the mesenteric veins, without warning. The risks are 8-11 times higher for pulmonary thrombosis, 3-6 times higher for myocardial infarction, based on previously used higher dosed pills. The frequency is about .5-1/1000, or 500-1000/year in France. Some of the cases described used pills with less than .05 mg estrogen, some were heavy smokers, 1 woman died, 1 had a lower extremity amputation, and 1 woman had demonstrated IgG lamda antibodies against ethinyl estradiol. Premonitory signs are rare, and unsually ignored. The immediate action is to stop the pill and start anticoagulants. The cause of these disorders is not known in detail, but is presumed to be estrogens, therefore, low-dose pills, i.e., those with .05 or .03 mg ethinyl estradiol, should be used if possible. Other risk factors are surgery, age, immobilization, history of vein disorders, smoking, hyperlipidemia, hypertension, especially since the pill potentiates hypertension, hyperlipidemia, and hypercoagulation. Some mechanisms proposed are hyperlipidemia, disturbed blood coagulation factors, decreased fibrinolysis, alterations in the blood vessel endothelium and immunity against the estrogen in the pill.
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PMID:[The thromboembolic risk of the pill]. 99 99


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