Combined oral contraceptive use among women with hypertension: a systematic review

Women with hypertension are at increased risk for cardiovascular events. Combined oral contraceptive (COC) use, even among low-dose users, has been associated with a small excess risk for cardiovascular events among healthy women. In this systematic review, we examined cardiovascular risks among COC users with hypertension. After searching MEDLINE for all articles published from 1966 through February 2005 relevant to COC use, hypertension and cardiovascular disease, we identified 25 articles for this review. Overall, these studies showed that hypertensive COC users were at higher risk for stroke and acute myocardial infarction (AMI) than hypertensive non-COC users, but that they were not at higher risk for venous thromboembolism (VTE). Women who did not have their blood pressure measured before initiating COC use were at higher risk for ischemic stroke and AMI, but not for hemorrhagic stroke or VTE, than COC users who did not have their blood pressure measured.