Medline ® Abstracts for References 4-6

Oral contraceptives and postmenopausal hormone therapy may induce hypertension through multiple mechanisms, including sodium and volume retention. Numerous studies have shown significant increases in blood pressure (BP) with the chronic administration of oral contraceptives as well as reversibility with discontinuation. The effects of different classes of oral contraceptive agents and hormonal replacement therapy on BP and associated effects on other cardiovascular risk factors are covered in this article. Novel hormonal replacement therapy that lowers BP is also discussed.

Combined oral contraceptives (COCs) may increase the risk for cardiovascular disease depending on the ethynyl estradiol (EE) dose and the androgenicity of the progestogens. Our objective was to evaluate the impact of a COC containing 20 mcg EE + 3 mg drospirenone on blood pressure (BP), renin-angiotensin-aldosterone system, insulin resistance, and androgenic profile of healthy young women. Eighty-one healthy young women aged 30 ± 1 years (case group, n = 49, received COC; control group, n = 32, used no COC) were assessed twice, before and after the 6-month study. Statistical analysis employed the paired t-tests and expressed the data in mean and standard deviation. Results were as follows: no changes in BP or in BMI; a significant increase in aldosterone, plasma renin activity, triglycerides, and total cholesterol levels, but a non-significant increase in HDL and no significant changes in LDL levels (these parameters remained within normal ranges); a significant increase in the HOMA-IR index and a significant decrease in dehydroepiandrosterone sulfate (SDHEA), androstenedione, total testosterone, and free testosterone levels; no significant variations in the control group parameters. An oral contraceptive combination of a low EE dose and an anti-androgenic progestogen does not negatively influence the risk factors for a cardiovascular disease.

UNLABELLED: The use of combined oral contraceptives is widespread among hypertensive women despite being associated with increased cardiovascular risk. Contraceptives containing drospirenone, which has antimineralocorticoid properties, may have a positive or neutral effect on neurohumoral activation and metabolic homeostasis of hypertensive women at reproductive age.

OBJECTIVES: To evaluate the effect of combined oral contraceptive containing drospirenone+ethinylestradiol on the systemic blood pressure, metabolic variables and neurohumoral axis in hypertensive women in reproductive age.

DESIGN: Prospective controlled trial with 56 hypertensive women allocated in two groups: 30 volunteers under oral combined contraceptive use and 26 volunteers using non-hormonal contraceptive methods. Subjects were tested before the introduction of the contraceptive method and 6 months after its use. For data acquisition, we used continuous non-invasive beat-to-beat blood pressure curve recordings and, for the biochemical and hormonal analyses two blood samples were obtained. Student's t test was used to determine differences between groups and moments and p<0.05 was considered statistically significant.

RESULTS: Comparing antropometric and blood pressure measurements, cardiac sympatho-vagal modulation, baroreceptor sensitivity, metabolic and neurohumoral axis variables between baseline and after 6 months, no significant difference was detected in each group or between groups. Except serum triglyceride levels which increased in the group of women using EE+DRSP after 6 months of use.

CONCLUSION: A contraceptive containing 20 mcg of ethinyl estradiol and 3 mg of drospirenone causes no significant changes in clinical and autonomic parameters, metabolic variables and neurohumoral axis of hypertensive women.