[Clinical aspects of hypertension under contraceptive steroids]

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.