Hi, my doctor said I can’t start the pill because I have high blood pressure, but I took it before and nothing bad happened. What’s the deal?
This is an important discussion because 25% of women of reproductive age in the United States have hypertension (high blood pressure) and yet only half of them know they have this condition. Shockingly, only 10% of women who know they have hypertension have their blood pressure controlled. We need to be talking about hypertension and women a lot more.
The deal here is the estrogen. The estrogen in estrogen-containing birth control pills (also called combined oral contraceptives or COCs) can worsen high blood pressure and increase the risk of heart attack and stroke (cardiovascular disease) for women with high blood pressure. Women 35 years or younger with well-controlled hypertension can take COCs if they don’t have other risk factors for heart attack and stroke. COCs should generally be avoided at any age with uncontrolled hypertension (meaning a blood pressure ≥ 140/90 mm Hg). Women with hypertension who are age 35 and older should also avoid COCs, even if their blood pressure is well-controlled. There is no issue with the progestin-only birth control pill.
A normal blood pressure is less than 120/80 mm Hg. Blood pressure is elevated when the top number, called the systolic blood pressure, is 120 to 129 mm Hg and the bottom number (diastolic blood pressure) is still less than 80 mm Hg. Hypertension (often referred to as high blood pressure) is diagnosed when the top number is 130 mm Hg or greater or the bottom number is 80 mm Hg or greater. Hypertension is a major risk factor cardiovascular disease, such as heart attack and stroke. High blood pressure can also damage the kidneys, the eyes, and increase the risk of dementia.
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