Malignant hypertension in young women is related to previous hypertension in pregnancy, not oral contraception.
Previous studies have suggested that one-third of women of childbearing age who develop malignant phase hypertension (MHT) are likely to be taking oral contraceptives (OC). We surveyed 104 women with a history of MHT. None of the 65 aged > 45 years were taking OC or other sex hormones. Thirty-nine (mean age 34.9 years, SD 8.0) were aged 15-44 years at presentation: 22 Caucasian, 10 Black/Afro-Caribbean and seven Indo-Asian. Of these 39, 22 had a history of hypertension in pregnancy (group 1), and 17 did not (group 2). Three of group 1 also had a history of OC-induced hypertension. None were pregnant, but one was taking an OC at presentation with MHT. Blood pressures at presentation and follow-up, and mean serum urea and creatinine at presentation were similar between groups, as was median survival (96 vs. 47 months, Lee-Desu statistic 0.75, p = 0.38). There was a trend towards poorer renal function at follow-up in group 1 patients, with higher mean serum urea and creatinine levels. The causes of death were renal failure (5), stroke (4) and heart disease (2). The OC was not a common cause of MHT-amongst our sample of women of childbearing age, but a past history of hypertension in pregnancy was important. Such patients also had a longer duration of hypertension and poorer renal function at follow-up.
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University Department of Medicine, City Hospital, Birmingham, UK.
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D000293:Adolescent; D000328:Adult; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006974:Hypertension, Malignant / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011379:Prognosis; D015996:Survival Rate
D003276:Contraceptives, Oral