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

Changes in blood pressure were measured at three-monthly intervals over one year in a prospective study of 704 women using an oral contraceptive (OC) containing levonorgestrel 250 ug with ethinyl estradiol 50 ug and 703 women using an intrauterine device (IUD). The study was conducted in 11 centres in seven developing and three developed countries. Women using OC developed systolic blood pressures which were 3.6-5.0 mmHg higher than those using IUDs; their diastolic pressures became 1.9-2.7 mm higher. The OC-induced change was not affected by climate, age, a family history of hypertension, stroke or heart disease or by a history of hypertension in pregnancy. The life-table rate of hypertension (BP 140/90 or more) in the first year of OC treatment was 0.6 +/- 0.4 in the developing countries and 1.1 +/- 0.8 in the developed ones, per 100 woman-years of use. The vasopressor response to OC varied widely between centres but was not obviously related to the economic development of the country.
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PMID:The WHO multicentre trial of the vasopressor effects of combined oral contraceptives: 1. Comparisons with IUD. Task Force on Oral Contraceptives. WHO Special Programme of Research, Development and Research Training in Human Reproduction. 250 94

Changes in blood pressure were measured in a randomized double-blind trial of 680 women using oral contraceptives containing either 50 or 30 ug of ethinyl estradiol combined with 250 mg levonorgestrel. The trial was done in 6 centres in Thailand, India, Zambia, Cuba, The Philippines, and Hungary. There were no significant differences between the two pills at any of 4 follow-up visits at approximately 3, 6, 9 and 12 months, nor in the life-table probability of developing hypertension within one year. These findings are evidence against the hypothesis that it is the estrogen in oral contraceptives which causes their vasopressor effect.
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PMID:The WHO multicentre trial of the vasopressor effects of combined oral contraceptives: 2. Lack of effect of estrogen. Task Force on Oral Contraceptives. WHO Special Programme of Research, Development and Research Training in Human Reproduction. 250 95

Vascular risk, mainly thromboembolitic risk, attributed to oral contraceptives (OCs) since 1962, has been primarily linked to ethinyl estradiol (EE). OCs which combine estrogen and have been associated with cerebral vascular accidents. A 1977 study showed a 40% increase of mortality due to cardiovascular complications in women taking OCs. There were of both an arterial and a venous character. The risk of myocardial infarction was 3 times more frequent among OC users. Deep venous thrombosis and pulmonary embolism were more numerous. Some other risk factors include smoking, hypertension, diabetes, and age 35. The risk of heart attack vanishes a few years after stopping OC use. The reduction of EE (and similarly progesterone) dosage from 100-50 mcg also lower the risk of hypertension, cerebral vascular accidents, and venous thrombosis. Prolonged use of OCs causes disorders of hemostasis affecting the walls of blood vessels, modifying the viscosity of blood flow (increase of hematocrits, reduction of venous tonus), modifying plasmatic coagulation (increase of platelets, increase of factors VII and X and plasma fibrinogen, and decrease of antithrombin III activity), and increased fibrinolysis. These anomalies are exclusively associated with high doses of estrogens. 5% of women using OCs develop moderate hypertension of 5-10 mm Hg of systolic pressure 5 years later, but after cessation it is reversed. OCs stimulate the renin-angiotensin-aldosterone system causing accelerated production of angiotensin II with the resultant forceful vasotension. 3 months after quitting OC use, high blood pressure returns to normal. EE can provoke diabetes; it increases very low density lipoprotein (VLDL) and high density lipoprotein (HDL) production, but total cholesterol is hardly affected. The androgenic property of progestogens reduces HDL. Combined OCs are contraindicated for women with hypertension, hyperlipidemia, diabetes, and a family history of vascular accidents.
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PMID:[Oral contraception and the vascular risk]. 251 20

The sudden drop of circulating estrogen in the premenopausal phase causes somatic and psychosomatic symptoms in women around the age of 40, which necessitates hormonal substitution and also reliable contraception because of the risk of pregnancy owing to irregular cycles. At this age the risks of pregnancy-related thrombosis, hypertension, and diabetes, perinatal mortality congenital anomalies, and maternal mortality are higher. Only 6.3-7.3% of women giving birth are over 35 years of age in Austria, but still 26% of women having an abortion are 36 years old or older. The rate of conception ranges between 2% and 5%, and when it falls below 1%, contraception is no longer necessary (around age 45-49). The IUD is acceptable and safe, and pelvic inflammatory disease does not play a significant role at this age. The most frequent side effects are spotting, hypermenorrhea, lower abdominal pain, and difficulties with intercourse. The introduction of micropills with an ethinyl estradiol dose of under 50 mcg and several agents, such as desogestrel, gestoden, and norgestimate, has made it possible to use them over the age of 40, provided no risk factors, such as metabolic disorders or smoking, are present. However, prior determination of lipid status is required. Sterilization is a final form of contraception when an increase of family size is no longer desired; whether the husband or the wife should be sterilized also poses a question. For female sterilization laparoscopy is used almost exclusively with bipolar diathermy, thermocoagulation, or binding with clips or rings. Hysterectomy is recommended in the case of myomatous uterus with cycle irregularities and hypermenorrhea. The condom, the diaphragm, or the natural temperature, Billings, or symptothermal methods have much higher failure rates. The physician has to advise women about the most suitable method.
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PMID:[Contraception and the climacteric]. 262 31

This guide to choice of oral contraceptives, for U.S. clinicians, includes a review of the available types of pills, the pharmacology of the steroids in pills, safety issues regarding thrombosis, arterial disease and hypertension related to estrogens and progestins in pills, common side effects, and therapeutic uses of orals. Choice of an oral contraceptive narrows down to which of the 5 available progestins and their formulation, since all contain ethinyl estradiol as the estrogen. While Briggs' theory espoused picking a pill with the minimal metabolic effect, recent evidence suggests that some estrogenic activity may be preferable to the unopposed progestagen, actually an anti-estrogenic receptor effect, to prevent adverse lipid and blood pressure effects in users. Current pills with low doses of estrogens probably are not significant risks for women as regards thrombosis, particularly if predisposed women and smokers are excluded. Pills containing 0.35 mg ethinyl estradiol and 0.5 mg norethindrone, based on large population trials, are probably the minimal effective dose yet even these are more effective than most other contraceptive methods. Breakthrough bleeding and spotting have been further minimized, however, with multiphasic pills. It is best to start with a 0.30-0.35 mg estrogen oral contraceptive, such as Loestrin, Demulin, Orthonovum 1.35, Orthonovum 7/7/7 or Nordette, encouraging the patient to accept early side effects for 3 months before switching to others. Disorders that can be managed with oral contraceptives include recurring and pre-existing ovarian cysts, endometriosis, dysfunctional uterine bleeding and dysmenorrhea. Brief guidelines for handling normal side effects and treatment of the above disorders are included.
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PMID:Choosing the best oral contraceptive. 274 45

Anthropometric, endocrine and metabolic variables, were examined in women with polycystic ovarian syndrome (PCO), and in normal control women. Obese women with PCO had higher plasma insulin values than non obese women with PCO, but lean body mass, glucose tolerance, plasma triglycerides and blood pressure were not different in spite of almost twice the body fat mass in the obese PCO women. However, in comparisons between non-obese PCO and control women, with equal body fat mass, the PCO women had higher blood pressure, plasma triglycerides and insulin, as well as a tendency to increased lean body mass. Both PCO groups had a high waist/hip ratio and larger abdominal fat cells than controls, indicating a preferential abdominal accumulation of adipose tissue. In comparison with abdominal adipocytes, femoral adipocytes were larger and had higher lipoprotein lipase activity in the control women, while in the PCO women these regional differences were not found. Basal and norepinephrine stimulated lipolysis were higher in the abdominal than femoral adipocytes in all groups. Substitution of the PCO women with ethinyl estradiol plus desogestrel during 6 months resulted in a regression of clinical androgenic symptoms as well as a normalization of plasma concentrations of free testosterone and sex hormone binding globulin. However, neither body composition nor metabolism were normalized. It was concluded that body fat distribution is more closely related to hypertension and metabolic derangements than total fat mass in the PCO syndrome. It is suggested that the relative paucity of femoral adipose tissue is due to a lack of specific effects of progesterone on adipocytes in this region.
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PMID:Anthropometric variables and metabolism in polycystic ovarian disease. 277 99

This article describes a case of focal pedunculated nodular hyperplasia, a rare form of benign liver tumor, and reviews the literature on focal nodular hyperplasia (FNH) and hepatocellular adenoma. Focal pedunculated nodular hyperplasia is the rarest form of FNH and accounts for fewer than 20% of cases. Hepatocellular adenoma is usually a single encapsulated tumor ranging in size from 1-30 cm in diameter. FNH is usually also a single tumor which is always polylobed and multinodular. The size is variable and it is well defined although not encapsulated. Microscopically neither FNH nor hepatocellular adenoma has normal portal spaces or centrolobular veins. A peliose (intratumoral pseudomicrocysts) is often observed in oral contraceptive (OC) users in both cases. Atypical, dysplasic, or neoplasic cells are observed in about 10% of cases of hepatocellular adenoma but have never been reported in FNH. Considerable hypervascularization is found in hepatocellular adenoma but not in FNH, although in FNH large vascular pedicel may be observed at the periphery. Both tumors are most frequently seen in fertile aged women. Over 1/3 of cases of hepatocellular adenoma are discovered due to intraperitoneal bleeding. FNH is asymptomatic in 73.5% of cases and hemoperitoneum is very rare. The case reported was that of a 40-year-old woman with no significant medical history who had used a combined OC containing ethinyl estradiol and norgestrel for 6 years until 2 years previously, when she terminated use due to subsequently controlled hypertension. A 6-month history of menorrhagia was uncontrolled despite use of an OC containing levonorgestrel only. The liver tumor was discovered in the course of a total hysterectomy performed because of a large polymyomatous uterus associated with significant menorrhagia. The FNH was surgically removed 2 months later. The tumor was highly vascularized and connected to segment 4 by a voluminous pedicel containing numerous thick vascular elements. The postoperative course was smooth. The relationship between OC use and benign hepatic tumors is now well established. Their overall frequency has been estimated at 4.9/million women aged 15-45. The duration of exposure to OCs seems to be a determining factor. The risk is negligible at durations of OC use under 1 year but is multiplied by 7 for FNH and by 5 for hepatocellular adenoma after 5 years. EE, mestranol, and 19 norsteroids all seem to play etiologic roles. 58% of hepatocellular adenomas in OC users are discovered because of hemoperitoneum following rupture. Bleeding is usually massive and the mortality rate is about 6%. FNH is revealed by bleeding in 15% of cases in OC users and is asymptomatic in 49% of users. Tumor development depends on whether OC use is continued. It is not currently known whether the tumors tend in the long run to degenerate into hepatic carcinoma, and whether OC use plays a role. The occurrence of liver cancer in OC users does not seem to be greater than in the general population, but OC users are younger at diagnosis, their survival time is longer, and alpha fetoprotein levels are not elevated. Surveillance of OC users is difficult because FNH is so often asymptomatic. Periodic sonograms after 5 years of OC use may be indicated.
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PMID:[A rare form of benign tumor of the liver possibly related to the use of oral contraceptives: focal pediculated nodular hyperplasia]. 299 1

Mechanism of action, indications, side effects and contraindications of oral contraceptive agents (OCA) are reviewed. OCA can be divided into two groups: consecutive and combined agents. Combined OCA contain both estrogens and gestagens and are taken for 3 weeks, while consecutive OCA contain only estrogens and are taken for 2 weeks followed by 1 week of combined OCA until the onset of menstruation. Biological activity of synthetic gestagens is estimated by a dosage which results in a delay of menstruation by 2 weeks. Gestagens norethindrone and norethynodrel were shown to be equally effective, while ethinodiol diacetate and norgestrel were 15-30 times more effective. Estrogen component of OCA is represented by ethinyl estradiol or mestranol. Combined OCA are more effective than consecutive OCA; probability of undesirable pregnancy during administration of combined OCA does not exceed 0.2%. The most frequent side-effects of OCA include nausea, headache, uterine hemorrhage, and changes in libido. OCA can affect the endocrine and reproductive systems. Major endocrine effects of OCA include changes in the cortisol metabolism in the adrenal glands, increase in the level of thyroid-binding globulin in the thyroid gland, changes in the glucose metabolism in the pancreas, inhibition of the luteinizing hormone releasing hormone in the hypothalamus with simultaneous decrease in the production of pituitary gonadotropins and inhibition of the ovulation. The most serious side-effects of OCA include cholelithiasis, thrombophlebitis, thromboembolism, liver adenoma, and myocardial infarction. Absolute contraindications to the use of OCA include hypertension, hyperlipidemia, breast or endometrial cancer, pregnancy, cardio-vascular diseases, liver diseases, and kidney insufficiency.
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PMID:[Principles of the use of oral contraceptive preparations]. 307 80

Arterial hypertension (AH) was reported for the 1st time as a side effect 5 years after the introduction of oral contraceptives (OCs) in the early 1960s. Most of the information associated with the risks of OC use was derived from the UK Royal College of General Practitioner's (RCGP) Oral Contraception Study of 1968, the UK Oxford/Family Planning Associates Contraceptive Study of 1968, and the US Walnut Creek/Kaiser Permanente Study of 1968 and 1977. These studies showed that AH and the risk of cardiovascular morbidity and mortality was significantly higher in women over 35 and who smoked because of the increased estradiol metabolism. In the 1960s the estrogen content in OCs was 50-150 mcg and the prostagen content was 10-10 mg. An average of 50 mcg estrogen and 1.5 mg of progestogen has been used since 1969. Low dose preparations in use since 1973 contain 30 mcg of estrogen and an equal dose of progestogen. The RCGP study of 1977 implicated norethisterone acetate (1, 3, and 4 mg used with 50 mcg of ethinyl estradiol EE), a progestogen, in hypertension. In a study of 78 women 15 were using an OC with 30 mcg of EE with 150 or 250 mcg of norgestrel and 63 women used a pill with 50 mcg of EE or mestranol with 1, 3, or 4 mg of norethisterone. The lower EE dose produced higher arterial pressure attributable to norgestrel. In 9 women taking OCs with 30 mcg of EE blood pressure dropped in a 1978 study of 50 women taking such low-dose pills, while the pressure increased in 100 other women taking on OC with 50 mcg of EE. Most relevant studies indicated a dose-response or type-response relationship between the progestogen component and arterial pressure. The estrogen component was also a major factor in OC-induced AH. The data implicate the involvement of the renin-angiotensin-aldosterone system, the direct effects of mineralocorticoids, and the adrenergic nervous system in the etiology of high blood pressure under OC use.
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PMID:[Oral contraceptives and arterial hypertension]. 307 32

Confirmation of a causal relationship between hemolytic-uremic syndrome (HUS) and verotoxin-producing Escherichia coli (VTEC) infection is provided by the case of a 22-year-old West German woman. The patient presented with fatigue, nausea, and headache. Ultrasonography revealed enlarged kidneys, and laboratory investigations showed uremia, hemolytic anemia, lactate dehydrogenase, haptoglobin below the detection limit, and thrombocytopenia. She received hemodialysis and drug treatment (heparin, dopamine, and furosemide). To investigate the kinetics of the humoral response to verotoxin, the patient was followed for 3 months. Fecal specimens on day 23 yielded E coli serotype 0111:NM, and stool filtrates on days 16 and 23 showed highly cytotoxic activity for HeLa cells. While the patient's initial serum showed a high IgM immune response against purified Shiga toxin, there was a steady decline in IgM and steady increase in IgG antibodies over the ensuing 3 months. These findings are suggestive of a recent infection by a verotoxin-producing organism. This is the 1st reported case of VTEC-associated HUS with e coli 0111 infection in an adult, and the patient's 4-year history of oral contraceptives (OCs)--ethinyl estradiol and chlormadinoneacetate--is considered to be of etiologic significance. The diminished antibody coating of bacteria in the urinary tract of OC users may have facilitated invasion of verotoxin across the mucosal barrier in this patient. Severe hypertension has been reported previously in OC users with HUS. It is speculated that verotoxin may trigger HUS in longterm OC users, initiating vasoconstriction and microangiopathic hemolysis.
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PMID:Hemolytic-uremic syndrome associated with an infection by verotoxin producing Escherichia coli 0111 in a woman on oral contraceptives. 328 32


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