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Original research article| Volume 90, ISSUE 5, P529-534, November 2014

Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol

      Abstract

      Objective

      Combined oral contraceptives (COCs) containing ethinyl-estradiol are known to increase blood pressure (BP). We evaluated whether COCs containing estradiol (E2) influence 24-h ambulatory BP and heart rate (HR) in normotensive and normal-weight women.

      Study design

      Twenty-four-hour BP and HR were measured every 30 min with an ambulatory BP device in 18 normotensive healthy non-smoking women prior to (Days 3–6 of menstrual cycle) and after 6 months of use (Days 20–24 of cycle 6) of a COC containing either a quadriphasic combination of E2 valerate plus dienogest (n=11) or a monophasic association of micronized E2 plus nomegestrol acetate (n=7).

      Results

      Mean age and body mass index of the final sample were 32.50±7.49 years and 22.87±4.08, respectively. E2-based COCs induced no modification of 24-h systolic BP (+1.65±8.34 mmHg; p=.41), diastolic BP (+0.04±7.36 mmHg; p=.98), mean BP (+0.64±6.42 mmHg; p=.68) or HR (−0.72±5.86 beats/min; p=.61). Differences were not observed even when daytime or nighttime values were separately considered. Though this was not a comparative study, we did not find differences between the effects of the two formulations (24-h mean BP; p=.699).

      Conclusions

      These data suggest a neutral effect of estradiol-based COCs on independent risk factors for cardiovascular diseases such as BP or HR.

      Implications

      BP and HR of normotensive women are not increased by E2-based COCs.

      Keywords

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      References

        • 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
        • Wilson E.S.
        • Cruickshank J.
        • McMaster M.
        • Weir R.J.
        A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen.
        Br J Obstet Gynaecol. 1984; 91: 1254-1260
        • 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
        • 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
        • Luque-Ramírez M.
        • Mendieta-Azcona C.
        • Alvarez-Blasco F.
        • Escobar- Morreale H.F.
        Effects of metformin versus ethinylestradiol 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
        • Cagnacci A.
        • Zanin R.
        • Napolitano A.
        • Arangino S.
        • Volpe A.
        Modification of 24-h ambulatory blood pressure and heart rate during contraception with the vaginal ring: a prospective study.
        Contraception. 2013; 88: 539-543
      1. Final results of the systolic hypertension in the elderly program (SHEP). Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.
        JAMA. 1991; 265: 3255-3264
        • Rich-Edwards J.W.
        • Manson J.E.
        • Hennerens C.H.
        • Buring J.C.
        The primary prevention of coronary heart disease in women.
        N Engl J Med. 1995; 332: 1758-1766
        • Lindberg U.B.
        • Crona N.
        • Stigendal L.
        • Teger-Nilsson A.C.
        • Silfverstolpe G.
        A comparison between effects of estradiol valerate and low dose ethinylestradiol on hemostasis parameters.
        Thromb Haemost. 1989; 6: 65-69
        • Cagnacci A.
        • Ferrari S.
        • Napolitano A.
        • Piacenti I.
        • Arangino S.
        • Volpe A.
        Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study.
        Contraception. 2013; 88: 413-417
        • Wiegratz I.
        • Lee J.H.
        • Kutschera E.
        • Winkler U.H.
        • Kuhl H.
        Effect of four oral contraceptives on hemostatic parameters.
        Contraception. 2004; 70: 97-106
        • Fruzzetti F.
        • Bitzer J.
        Review of clinical experience with estradiol in combined oral contraceptives.
        Contraception. 2010; 81: 8-15
        • Agren U.M.
        • Anttila M.
        • Mäenpää-Liukko K.
        • et al.
        Effects of a monophasic combined oral contraceptives containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on hemostasis, lipids and carbohydrate metabolism.
        Eur J Contracept Reprod Health Care. 2011; 16: 444-457
        • Grandi G.
        • Piacenti I.
        • Volpe A.
        • Cagnacci A.
        Modification of body composition and metabolism during oral contraceptives containing non-androgenic progestins in association with estradiol or ethinyl-estradiol.
        Gynecol Endocrinol. june 11, 2014; https://doi.org/10.3109/09513590.2014.92294
        • Junge W.
        • Mellinger U.
        • Parke S.
        • Serrani M.
        Metabolic and hemostatic effects of estradiol valerate/dienogest, a novel oral contraceptive: a randomized, open-label, single-centre study.
        Clin Drug Investig. 2011; 31: 573-584
        • Conard J.
        • Basdevant A.
        • Thomas J.L.
        • et al.
        Cardiovascular risk factors and combined estrogen-progestin replacement therapy: a placebo controlled study with nomegestrol acetate and estradiol.
        Fertil Steril. 1995; 64: 957-962
        • Fox K.
        • Borer J.S.
        • Camm J.
        • et al.
        • 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 response to increased heart rate.
        J Am Coll Cardiol. 2010; 56: 1973-1983
        • Schipper I.
        • Hop W.C.
        • Fauser B.C.
        The follicle-stimulating hormone (FSH) threshold/window concept examined by different interventions with exogenous FSH during the follicular phase of the normal menstrual cycle: duration, rather than magnitude, of FSH increase affects follicle development.
        J Clin Endocrinol Metab. 1998; 83: 1292-1298
      2. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) guidelines for the management of arterial hypertension.
        Eur Heart J. 2007; 28: 1462-1536
        • Cagnacci A.
        • Rovati L.
        • Zanni A.L.
        • Malmusi S.
        • Facchinetti F.
        • Volpe A.
        Physiological doses of estradiol decrease nocturnal blood pressure in normotensive postmenopausal women.
        Am J Physiol. 1999; 276: H1355-H1360
        • Hodgkinson J.A.
        • Sheppard J.P.
        • Heneghan C.
        • et al.
        Accuracy of ambulatory blood pressure monitors: a systematic review of validation studies.
        J Hypertens. 2013; 31: 239-249
        • Mueck A.O.
        • Sitruk-Ware R.
        Nomegestrol acetate, a novel progestogen for oral contraception.
        Steroids. 2011; 76: 531-539
        • 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
        • 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 Cardiol 2011. 2011; 924343https://doi.org/10.5402/2011/924343
        • Palatini P.
        Heart rate as a cardiovascular risk factor: do women differ from men?.
        Ann Med. 2001; 33: 213-221