Contraceptive-induced hypertension appears to be related to the progestogenic, not the estrogenic, potency of the preparation

Contraceptive-induced hypertension appears to be related to the progestogenic, not the estrogenic, potency of the preparation. Regular monitoring of BP throughout contraceptive therapy is recommended, and it has been suggested that the duration of prescription contraceptive use be limited to 6 months to ensure at least semiannual reevaluations. of hypertension compared with men. The highest prevalence rates of hypertension are observed in elderly black women, with hypertension occurring in >75% of black women older than 75 years. Awareness, Treatment, and Control of Hypertension in Women Women are more likely than men to know that they have hypertension and to seek treatment. However, recent analysis of the data from the National Health and Nutrition Examination Survey (NHANES) LIN28 inhibitor LI71 show a lag in control rates among women compared with men. In Mouse monoclonal to CD4.CD4, also known as T4, is a 55 kD single chain transmembrane glycoprotein and belongs to immunoglobulin superfamily. CD4 is found on most thymocytes, a subset of T cells and at low level on monocytes/macrophages NHANES 1999C2004, approximately 68% of hypertensive women were aware of their high blood pressure (BP) in contrast with 67% of hypertensive men. Overall, 58% of hypertensive women but only 52% of hypertensive men were being treated with antihypertensive medication. The higher treatment rates in women have been attributed to increased numbers of physician contacts. Control rates for treated male hypertensive patients is 66% compared with 62.5% among women, which represents a reversal of the observation from 2001 and 2002 when 65.2% of women vs 62.6% of men had controlled BP. This difference in control rates did not reach statistical significance. Etiology and Pathophysiology of Hypertension in Women Most (90%C95%) hypertension in the United States is essential hypertension; however, 5% to 10% of hypertension has a well-defined etiology. Most secondary hypertension generally occurs with equal frequency in women and men. Exceptions include hypertension caused by renal artery stenosis due to fibromuscular dysplasia, which occurs more commonly in women than men, and secondary hypertension due to the use of oral contraceptives, preeclampsia, and vasculitides. Although there are exceptions in individual patients, hypertensive women tend to have lower plasma renin activity (PRA) than hypertensive men. PRA, intravascular volume, and BP vary during the menstrual cycle in normotensive women. The increase in intravascular volume during the luteal phase of the menstrual cycle may play a role in hypertension in some women and may account in part for hypertension associated with use of oral contraceptives. Karpanou and colleagues demonstrated that premenopausal hypertensive women have increased testosterone levels during ovulation and increased testosterone and PRA during the luteal phase of the menstrual cycle. In this study, hypertensive women with high PRA exhibited no change in BP during the cycle (much like normotensive patients), whereas hypertensive women with relatively low PRA had a nighttime increase in BP during ovulation. The authors speculate that BP may be regulated mainly by the renin-angiotensin-aldosterone system in hypertensive persons with high LIN28 inhibitor LI71 PRA, whereas sex steroids may play a more important role in those with low PRA. In premenopausal women, hypertension is often characterized by a higher resting heart rate, left ventricular ejection time, cardiac index, and pulse pressure and a lower total peripheral resistance and total blood volume compared with age-matched men with the same BP level. Hypertension in older women tends to be characterized by elevated peripheral vascular resistance, low or normal plasma volume, and a tendency toward low PRA. Oral Contraceptives and BP Many women taking oral contraceptives experience a small but detectable increase in BP; a small percentage experience LIN28 inhibitor LI71 the onset of frank hypertension. This is true even with modern preparations that contain only 30 g estrogen. The Nurses’ health study found that persons currently LIN28 inhibitor LI71 using oral contraceptives had a significantly increased risk of hypertension compared with those who had never used oral contraceptives (relative risk, 1.8; 95% confidence interval, 1.5C2.3). Absolute risk was small: only 41.5 cases of hypertension per 10,000 personyears could be attributed to oral contraceptive use. Controlled prospective studies have demonstrated a return of BP to pretreatment levels within 3 months of discontinuing oral contraceptives, indicating that their BP effect is readily reversible. Oral contraceptives occasionally may precipitate accelerated or malignant hypertension. Family history of hypertension, including preexisting pregnancy-induced hypertension, occult renal disease, obesity, middle age (>35 years), and duration of oral contraceptive use increase susceptibility to.