The heterogeneity of the blood pressure response to hormonal contraceptives

The association between hypertension and oral contraceptives (OCs) has been recognized since the 1960s. Most studies of high— and low-dose estrogen-containing OCs from the 1970s and 1980s support a several millimeter rise in blood pressure, although only some women become hypertensive. Varying types and doses of estrogens and progestins in the OCs studied, heterogeneity in racial composition of the study populations, and varying duration of treatment all contribute to the conflicting results. Over the past decade, new hormonal contraceptives have come into use, including progestin-only contraceptives and a new generation of combination OCs incorporating less androgenic progestins. Therefore, results of earlier studies cannot be applied to today's agents. The mechanisms of hormonal contraceptive-induced hypertension are uncertain. They may involve the renin-angiotensin-aidosterone system, hyperinsulinemia, and a genetic predisposition. A better understanding of the heterogeneity of blood pressure response to hormonal contraceptive requires the study of specific agents in specific populations.