Advertisement
Original research article| Volume 88, ISSUE 3, P413-417, September 2013

Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study

      Abstract

      Background

      Hypertension is a primary cardiovascular risk factor. Oral contraceptives (OCs) may increase blood pressure and cardiovascular events. We evaluated whether an OC containing ethynylestradiol (EE) in association with the spironolactone-derived progestin drospirenone (DRSP) influences 24-h ambulatory blood pressure of normotensive women.

      Study Design

      Twenty-four-hour blood pressure was measured every 30 min by an ambulatory blood pressure device in 18 normotensive healthy women prior to and after 6 months of use of an OC containing 30 mcg EE and 3 mg DRSP.

      Results

      OC induced no modification in 24-h, nighttime and daytime blood pressure. Heart rate increased about 4 beats/min in the 24-h (p<.05) and daytime (p<.02) measurements.

      Conclusions

      In normotensive women, an OC containing 30 mcg EE plus 3 mg DRSP does not modify blood pressure, and significantly increases 24-h and daytime heart rate. These data suggest a neutral effect on hypertension-associated cardiovascular risk and point out an unreported effect on heart rate of which cause and effect require further evaluation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • et al.
        Heart disease and stroke statistics — 2011 update: a report from the American Heart Association.
        Circulation. 2011; 123: 18-209
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Ischaemic stroke and combined oral contraceptives: results of an international multicentre case control study.
        Lancet. 1996; 348: 498-505
        • World Health Organization
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case–control study.
        Lancet. 1996; 348: 505-510
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case–control study.
        Lancet. 1997; 349: 1202-1209
        • Meade T.W.
        • Haines A.P.
        • North W.R.S.
        • Chakrabarti R.
        • Howarth D.J.
        • Stirling Y.
        Haemostatic, lipid and blood-pressure profiles of women on oral contraceptives containing 50 μg or 30 μg oestrogen.
        Lancet. 1977; 2: 948-951
        • Wilson E.S.B.
        • Cruickshank J.
        • McMaster M.
        • Weir R.J.
        Br. A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen.
        J Obstet Gynaecol. 1984; 91: 1254-1260
      1. World Health Organization. Medical eligibility criteria for contraceptive use (4thed.) World organization (2009) fromhttp://whqlibdoc.who.int/publications/2009/9789241563888_eng.pdf.

        • Narkiewicz K.
        • Graniero G.R.
        • D'Este D.
        • Mattarei M.
        • Zonzin P.
        • Palatini P.
        Ambulatory blood pressure in mild hypertensive women taking oral contraceptives. A case–control study.
        Am J Hypertens. 1995; 8: 249-253
        • Weir R.J.
        • Briggs E.
        • Mack A.
        • Naismith L.
        • Taylor L.
        • Wilson E.
        Blood pressure in women taking oral contraceptives.
        Br Med J. 1974; 1: 533-535
        • Fisch I.R.
        • Frank J.
        Oral contraceptives and blood pressure.
        JAMA. 1977; 237: 2499-2503
        • Weir R.J.
        Effect on blood pressure of changing from high to low dose steroid preparations in women with oral contraceptive induced hypertension.
        Scott Med J. 1982; 27: 212-215
        • Fuchs N.
        • Dusterberg B.
        • Weber-Diehl F.
        • Muhe B.
        The effect on blood pressure of a monophasic oral contraceptive containing ethinylestradiol and gestodene.
        Contraception. 1995; 51: 335-339
        • Weir R.J.
        Blood pressure in women taking oral contraceptives.
        Am Heart J. 1976; 92: 119-120
        • Godsland I.F.
        • Crook D.
        • Devenport M.
        • Wynn V.
        Relationships between blood pressure, oral contraceptive use and metabolic risk markers for cardiovascular disease.
        Contraception. 1995; 52: 143-149
        • Briggs M.
        Oestrogen content of oral contraceptives.
        Lancet. 1977; 2: 1233
        • Leaf D.A.
        Women and coronary artery disease.
        Postgrad Med. 1990; 87: 55-60
        • De Leo V.
        • La Marca A.
        • Morgante G.
        • et al.
        Evaluation of plasma levels of renin-aldosterone and blood pressure in women over 35 years treated with new oral contraceptives.
        Contraception. 2001; 64: 145-148
        • Cardoso F.
        • Polónia J.
        • Santos A.
        • Silva-Carvalho J.
        • Ferreira-de-Almeida J.
        Low-dose oral contraceptives and 24-hour ambulatory blood pressure.
        Int J Gynaecol Obstet. 1997; 59: 237-244
        • Luque-Ramírez M.
        • Mendieta-Azcona C.
        • Alvarez-Blasco F.
        • Escobar-Morreale H.F.
        Effects of metformin versus ethinyl-estradiol plus cyproterone acetate on ambulatory blood pressure monitoring and carotid intima media thickness in women with the polycystic ovary syndrome.
        Fertil Steril. 2009; 91: 2527-2536
        • Straznicky N.E.
        • Barrington V.E.
        • Branley P.
        • Louis W.J.
        A study of the interactive effects of oral contraceptive use and dietary fat intake on blood pressure, cardiovascular reactivity and glucose tolerance in normotensive women.
        J Hypertens. 1998; 16: 357-368
        • Skinner S.L.
        • Lumbers E.R.
        • Symonds E.M.
        Alteration by oral contraceptives of normal menstrual changes in plasma renin activity, concentration and substrate.
        Clin Sci. 1969; 36: 67-76
        • Elger W.
        • Beier S.
        • Pollow K.
        • et al.
        Conception and pharmacological profile of drospirenone.
        Steroids. 2003; 68: 891-905
        • Elger W.
        • Steinbeck H.
        • Schillinger E.
        • et al.
        Endocrine pharmacological profile of gestodene E.
        in: Elstein Gestodene. Development of a new gestodene-containing low dose oral contraceptive. Parthenon Publishing, Carnforth (UK)1987: 19-33
        • Oelkers W.
        Antimineralocorticoid activity of a novel oral contraceptive containing drospirenone, a unique progestogen resembling natural progesterone.
        Eur J Contracept Reprod Health Care. 2002; 7: 19-26
        • Fox K.
        • Borer J.S.
        • Camm J.
        • et al.
        • for the Heart Rate Working Group
        Resting heart rate in cardiovascular disease.
        J Am Coll Cardiol. 2007; 50: 823-830
        • Custodis F.
        • Schirmer S.H.
        • Baumhakel M.
        • Heusch G.
        • Bohm M.
        • Laufs U.
        Vascular pathophysiology in resonse to increased heart rate.
        J Am Coll Cardiol. 2010; 56: 1973-1983
        • Asche C.V.
        • Kim J.
        • Kularni A.S.
        • Chakravarti P.
        • Andersson K.-E.
        Assessment of association of increased heart rates to cardiovascular events among healthy subjects in the United States: analysis of primary care electronic medical records database.
        ISRN Cardiology. 2011; 2011: 924343https://doi.org/10.5402/2011/924343
        • The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) guidelines for the management of arterial Hypertension
        Eur Heart J. 2007; 28: 1462-1536
        • Cagnacci A.
        • Cannoletta M.
        • Renzi A.
        • Baldassari F.
        • Arangino S.
        • Volpe A.
        Prolonged melatonin administration decreases nocturnal blood pressure in women.
        Am J Hypertens. 2005; 18: 1614-1618
        • Tu Y.K.
        • Gilthorpe M.S.
        Revisiting the relation between change and initial value: a review and evaluation.
        Statist Med. 2007; 26: 443-457
        • White W.B.
        • Hanes V.
        • Chauhan V.
        • Pitt B.
        Effects of a new hormone therapy, drospirenone and 17-beta-estradiol, in postmenopausal women with hypertension.
        Hypertension. 2006; 48: 246-253
        • Yildizhan R.
        • Yildizhan B.
        • Adali E.
        • Yoruk P.
        • Birol F.
        • Suer N.
        Effects of two combined oral contraceptives containing ethinylestradiol 30 mcg combined with either gestodene or drospirenone on hemostatic parameters, lipid profiles and blood pressure.
        Arch Gynecol Obstet. 2009; 280: 255-261
        • Suthipongse W.
        • Taneepanichskul S.
        An open-label randomized comparative study of oral contraceptives between medications containing 3 mg drospirenone/30 microg ethinylestradiol and 150 microg levonogestrel/30 microg ethinylestradiol in Thai women.
        Contraception. 2004; 69: 23-26
        • Battaglia C.
        • Mancini F.
        • Fabbri R.
        • et al.
        Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study.
        Fertil Steril. 2010; 94: 1417-1425
        • Cagnacci A.
        • Baldassari F.
        • Arangino S.
        • Alessandrini C.
        • Volpe A.
        Administration of tibolone decreases 24 h heart rate but not blood pressure of post-menopausal women.
        Maturitas. 2004; 48: 155-160
        • Reinberg A.E.
        • Touitou Y.
        • Soudant E.
        • Bernard D.
        • Bazin R.
        • Mechkouri M.
        Oral contraceptives alter circadian rhythm parameters of cortisol, melatonin, blood pressure, heart rate, skin blood flow, transepidermal water loss, and skin amino acids of healthy young women.
        Chronobiol Int. 1996; 13: 199-211
        • Buss S J.
        • Backs J.
        • Kreusser M.M.
        • et al.
        Spironolactone preserves cardiac norepinephrine reuptake in salt-sensitive Dahl rats.
        Endocrinology. 2006; 147: 2526-2534
        • Munakata M.
        • Imai Y.
        • Hashimoto J.
        • et al.
        Normal sympathetic vasomotor and cardiac parasympathetic activities in patients with primary aldosteronism: assessment by spectral analysis.
        J Auton Nerv Syst. 1995; 52: 213-223
        • Fruzzetti F.
        • Lazzarini V.
        • Ricci C.
        • Quirici B.
        • Gambacciani M.
        • Paoletti A.M.
        • et al.
        Effect of an oral contraceptive containing 30 microg ethinylestradiol plus 3 mg drospirenone on body composition of young women affected by premenstrual syndrome with symptoms of water retention.
        Contraception. 2007; 76: 190-194
        • Palatini P.
        Heart rate as a cardiovascular risk factor: do women differ from men?.
        Ann Med. 2001; 33: 213-221