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  • Title: Estrogens and hypertension.
    Author: Weinberger MH.
    Journal: Compr Ther; 1982 Jun; 8(6):71-5. PubMed ID: 7105645.
    Abstract:
    New information concerning the risk of mild unrecognized increased in blood pressure on mortality and a new definition of normal blood pressure levels necessitate reevaluation of the relationships between oral contraceptives (OCs) or estrogens and blood pressure changes. Several aspects of the relationship of OCs to blood pressure and to cardiovascular diseases can be summarized. A rise in blood pressure occurs in virtually all women who use OCs for 6 months or longer. These prospective studies involved 60,000 women, 35,000 of them using birth control pills. After 5 years of OC use, a mean increase in systolic pressure of 12.3 mm Hg and of diastolic, 8.8 mm Hg was seen in these normotensive females. The current evidence indicates that a high risk group likely to develop contraceptive hypertension cannot be identified, but there are characteristics which are known to increase the risk of cardiovascular disease such as heart attacks and strokes in all OC users. These include cigarette smoking, diabetes, and hyperlipidemia. In such susceptible persons, extreme caution is advised in prescribing estrogens in order to reduce the likelihood of premature cardiovascular disease. The increase in blood pressure associated with OC administration is generally mild, yet it may be progressive. Discernible increases in blood pressure normally occur as early as 6 months after OC use begins, and the greatest increase in blood pressure is usually seen during the 1st 2 years of OC use. It is prudent to monitor blood pressure at least every 6 months in women receiving estrogens and OCs. Developing the most effective therapeutic approach to estrogen induced hypertension, when withdrawal of the estrogen source is not feasible, would be enhanced by a clear understanding of the mechanisms by which the hypertension occurs. In general, any of these mechanisms can increase blood pressure independently or in combination: fluid volume expansion, vasoconstriction, and the sympathetic nervous system. The influence of estrogens on these factors is reviewed. When hypertension is encountered in a woman receiving estrogens, the ideal 1st step is discontinuation of the estrogen source. In some patients the severity of the hypertension or the presence of complications necessitates emergency treatment. The use of diuretics, antisympathetic agents, vasodilators, and parenteral agents for malignant hypertension represents an appropriate sequence to follow in such cases.
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