Arterial Hypertension and its Impact on the Prescription of Combined Hormonal Contraception

Combined hormonal contraception (CHC) is a widely accepted contraceptive method for women of reproductive age. It is considered a safe and user-friendly option for women without risk factors for cardiovascular diseases; however, it is contraindicated in women with established cardiovascular disease or overt risk factors. CHC increases the incidence of cardiovascular events through higher risk for thromboembolic events and potential increases of blood pressure.

The aim of this article was to explain when and how arterial hypertension should be addressed as absolute and relative contraindication for CHC use as well as a possible consequence of CHC therapy.

This is descriptive method which should be crucial to identify women who are not suitable candidates for CHC by thoroughly assessing their medical history, including current and previous conditions, evaluating potential risk factors, calculating body mass index (BMI), and regularly monitoring blood pressure and weight.

Several explanations have been proposed to explain blood pressure elevations. The estrogenic component in CHC stimulates renin-angiotensin-Aldosterone system (RAAS) through increased hepatic production of angiotensinogen. The regulation of anti-diuretic hormone (ADH) through osmoreceptors may also be altered. Before prescribing CHC, gynecologists should conduct a thorough cardiovascular risk assessment. This should include a targeted questionnaire addressing cardiovascular disease history and risk factors, such as smoking and elevated lipid levels. Additionally, BMI calculation and blood pressure measurement should be performed. It is advisable to assess thyroid function by measuring THS levels at the initiation of CHC and every five years thereafter, as thyroid dysfunction is associated with increased cardiovascular risk, particularly arterial hypertension Laboratory testing should include lipid profiles, glucose levels and thyroid function assessment performed prior to initiating CHC and at regular intervals during its use. This article focuses on arterial hypertension addressing its role as both an absolute and relative contraindication for CHC use as well as a possible consequence of CHC therapy.

Women with well-controlled arterial hypertension may, in certain circumstances, safely use CHC. The combination of estetrol and drospirenone holds promise as an ideal choice for women with arterial hypertension seeking CHC.