Blood pressure measurement prior to initiating hormonal contraception: a systematic review

Women with hypertension who use hormonal methods of contraception may have an increased risk for cardiovascular events. This review was conducted to evaluate the evidence regarding whether blood pressure should be measured prior to initiating hormonal contraceptives.

The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning blood pressure measurement prior to initiation of hormonal contraceptives. Articles were included if they reported on women with and without blood pressure measurement prior to current hormonal contraceptive usage and assessed cardiovascular outcomes. The quality of each study was assessed using the United States Preventive Services Task Force grading system.

Six fair-quality articles from three studies met inclusion criteria for this review. Three case-control studies showed that women who did not have blood pressure measurement prior to initiating combined oral contraceptives (COCs) had a higher risk for acute myocardial infarction (AMI) than women who did have blood pressure measurement. Two case-control studies showed that women who did not have blood pressure measurement prior to initiating COCs had a higher risk for ischemic stroke than women who did have blood pressure measurement. One case-control study showed no difference in the risk for hemorrhagic stroke among women who initiated COCs based on whether or not blood pressure was measured.

Fair-quality evidence from five reports showed that women who did not have blood pressure measurement prior to COC initiation had a higher risk for AMI and ischemic stroke than women who did have blood pressure measurement. One fair-quality study showed no increased risk for hemorrhagic stroke based on whether or not blood pressure was measured. Studies that examined hormonal contraceptive methods other than COCs were not identified.