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JAMA Insights
Women's Health
September 21, 2020

Hormonal Contraception in Women With Hypertension

Author Affiliations
  • 1Smidt Heart Institute, Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
JAMA. 2020;324(14):1451-1452. doi:10.1001/jama.2020.11935

Hypertension, defined as a systolic blood pressure (SBP) of at least 130 mm Hg or diastolic blood pressure (DBP) of at least 80 mm Hg, is a major risk factor for cardiovascular disease (CVD). In the US, approximately 25% of women of reproductive age have hypertension.1 Of these, less than half are aware of their diagnosis and, when diagnosed, only 10% have their blood pressure (BP) controlled.1 Further, racial differences exist, with more than half of Black women aged 20 years or older having hypertension.1 Selecting the appropriate hormonal contraception in women with hypertension is important because several of these contraceptives increase BP and, in those with established hypertension, increase the risk for stroke and myocardial infarction (Figure). This Insights provides guidance in selecting hormonal contraception given that hypertension can be either a relative or absolute contraindication.

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