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  • Title: [Clinical aspects of hypertension under contraceptive steroids].
    Author: Kaulhausen H, Klingsiek L.
    Journal: Fortschr Med; 1976 Dec 02; 94(34):2005-13. PubMed ID: 793966.
    Abstract:
    In Europe, about 1 per cent of women using oral contraceptives develop hypertension. The frequency seems to increase with age and in women who had earlier shown hypertensive disorders of pregnancy. A failure in the feedback mechanisms of the renin-angiotensin-aldosterone system is suggested to be an important factor in the etiology of hypertension induced by oral contraceptives. Usually, blood pressure returns to normal after cessation of treatment with contraceptive steroids; on the other hand, some cases of irreversible hypertension and kidney failure have been described. Besides the measurement of blood pressure before any treatment with hormonal contraceptives is started, blood pressure should be controlled after three months. In the differential diagnosis of hypertension induced by oral contraceptives, primary aldosteronism and renal artery stenosis have to be excluded; these hypertensive disorders show similar biochemical changes, but should be treated by surgical intervention. The choice of other contraceptives by women with this type of hypertensive disease is discussed. 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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