title: Modification of 24-h ambulatory blood pressure and heart rate during contraception with the vaginal ring: a prospective study.
abstract: BACKGROUND
  Hypertension is recognized as a major risk factor for coronary, cerebral and renal vascular disease. Hormonal methods of contraception may increase the risk for cardiovascular events. We evaluated whether the combined hormonal contraceptive vaginal ring that releases 15-mcg ethinylestradiol and 120 mcg of etonogestrel each day influences 24-h ambulatory blood pressure.
  
  
  METHODS
  At baseline, ambulatory blood pressure was automatically monitored every 30 min for 41 h in 18 normotensive healthy women during their follicular phase (Days 3-6). Each subject was immediately treated with the vaginal ring for six cycles. Monitoring of ambulatory blood pressure was repeated in the last days of the sixth cycle of treatment.
  
  
  RESULTS
  During the vaginal ring, a significant increase was observed for 24-h diastolic (2.75±5.13 mmHg; p=.03) and mean (2.69±5.35 mmHg; p=.048) blood pressure and for daytime diastolic (3.04±6.36 mmHg; p=.05) blood pressure. No variation was found in nighttime blood pressure. Heart rate increased in the 24-h period (3.39±5.85 beats/min; p=.025) and in the daytime (3.38±6.25 beats/min; p=.034) measurements.
  
  
  CONCLUSIONS
  In normotensive women, the vaginal ring slightly increases 24-h blood pressure and heart rate. The underlying mechanisms and the clinical impact of these slight modifications require further evaluation.
authors.affiliation: Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena, Modena, Italy. Electronic address: cagnacci@unimore.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cagnacci
authors.forename: Renata
authors.initials: R
authors.lastname: Zanin
authors.forename: Antonella
authors.initials: A
authors.lastname: Napolitano
authors.forename: Serenella
authors.initials: S
authors.lastname: Arangino
authors.forename: Annibale
authors.initials: A
authors.lastname: Volpe
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D003274:Contraceptive Devices, Female / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D017135:Desogestrel / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005498:Follicular Phase / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D004967:Estrogens; C044815:etonogestrel; D004997:Ethinyl Estradiol; D017135:Desogestrel
keywords: Blood pressure; Diurnal, Ambulatory monitoring; Heart rate, Hypertension; Vaginal contraception