Abstract
Malignant hypertension (MH) has been described in association with high-dose (50 - 100 mcg) estrogen oral contraceptive pills (OCPs). Although the rise in blood pressure (BP) is usually mild, some women will have a more significant increase in BP, and hypertensive emergencies may very rarely occur. We present a 21-year-old Caucasian female with a past medical history of fibromyalgia and family history of hypertension (both grandparents) who was admitted with a three-day history of headache and blurring of vision in her left eye with a BP of 210/150. Her medications, which were continued on admission, included tramadol, 100 mg twice daily (bid), and low-dose estrogen OCP. During the hospital course, she received different antihypertensive medications and her hypertension was controlled. A diagnosis of MH due to OCP was made. All antihypertensive medications were stopped, except metoprolol, and the patient was discharged home on metoprolol with a BP of 107/55 mmHg. On follow-up in the medical clinic three months later, her visual disturbances had completely resolved and her BP was 98/56 mmHg. One-third of patients aged 15 - 44 years old who develop MH are likely to be on high-dose estrogen OCP. As far as we know, our case is the third documented case of MH occurring in patients on low-dose estrogen OCP. Chronic use of oral contraceptives will slightly increase the systemic BP in most women. It is advisable to avoid OCP in high-risk patients and do regular BP checks on patients on OCP. In patients presenting with hypertension or MH while on OCP, the OCP should be discontinued.
Highlights
For millions of women, oral contraceptive pills (OCPs) are an effective way to prevent an unwanted pregnancy, get irregular periods back on track, and help clear up problems due to hormonal shifts, such as acne
In patients presenting with hypertension or Malignant hypertension (MH) while on OCP, the OCP should be discontinued
We present a case of MH developing in a patient within two years of commencing OCP containing low-dose (30 mcg) estrogen
Summary
Oral contraceptive pills (OCPs) are an effective way to prevent an unwanted pregnancy, get irregular periods back on track, and help clear up problems due to hormonal shifts, such as acne. We present a case of MH developing in a patient within two years of commencing OCP containing low-dose (30 mcg) estrogen. A 21-year-old Caucasian female with a past medical history of fibromyalgia and a family history of hypertension (both grandparents) was admitted with a three-day history of headache and blurring of vision in her left eye Her BP was 210/150 and physical examination was essentially normal, apart from the visual acuity of 6/4 (right eye) and 6/1 (left eye) with papilledema. An electrocardiogram was significant for left ventricular hypertrophy (LVH) (Figure 1), an echo showed LVH and an ejection fraction of 45%, and a transesophageal echocardiogram confirmed an incidental leiomyomatous interventricular septum Her medications, which were continued on admission, included tramadol, 100 mg twice daily (bid), and low-dose estrogen OCP. The metoprolol was stopped, and a BP check one year later was 103/58 mmHg
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