Oral contraceptives are associated with increased blood pressure even when women use newer products containing dosages of 30 mg of ethinyl estradiol and 150 mg of progestin. DMPA progestin-only pills and IUD use does not appear to increase baseline blood pressure. In deciding whether or not to use combination hormonal contraceptives in women with hypertension, risk of adverse events should be balanced against the known adverse pregnancy outcomes associated with hypertension. Healthy non-smoking women with well-controlled hypertension, no evidence of end organ damage and who are <35 years may be appropriate candidates for a trial of combination contraceptives. If blood pressure remains well controlled several months after contraceptive initiation, and is closely followed up, its use can be continued. Although data are non-existent or inconclusive, it would probably be prudent to consider other combination hormonal contraceptive products (transdermal, vaginal ring) in the same manner as oral hormonal contraceptives. For hypertensive women, progestin-only contraceptives, such as DMPA, POPs, or the levonorgestrel intrauterine system, or copper IUD are appropriate options.
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