Blood pressure response to estrogen-progestin oral contraceptive after pregnancy-induced hypertension

Abstract

Blood pressures have been measured before and during use of an oral contraceptive (mestranol, 50 mcg., plus norethindrone, 1 mg.) by 180 young primiparous women who had recently demonstrated overt pregnancy-induced hypertension, including 26 with eclampsia. Their mean systolic and diastolic blood pressures varied from no higher to only very slightly higher than those of 200 nulligravid women who were using the same contraceptive. The diastolic blood pressures rose to exceed 90 mm. Hg in nine of the women who were previously hypertensive late in their first pregnancies compared to a similar rise in five of the nulligravid women. In the majority of the nine with previous pregnancy-induced hypertension, but in none of the five nulligravid women, the hypertension was identified during the first 3 months after starting the oral contraceptive and persisted long after the contraceptive was stopped. The basis of the hypertension that reappeared during the first 3 months of use of the oral contraceptive as well as during the pregnancy, was most likely underlying chronic vascular disease. Absence of hypertension while using the oral contraceptive did not preclude the subsequent development of hypertension during pregnancy either by primiparous women with previous pregnancy-induced hypertension or by primigravid women. The observations reported here do not preclude the use of the oral contraceptive by young primiparous women with previous pregnancy-induced hypertension, including eclampsia, if one adheres to the contraceptive dosage, the method of patient selection, and the guidelines for follow-up cutlined in this article.