28 Boletín Hipertensión VOL 26. 2025 / 22 - 28 Hipertensión arterial y métodos anticonceptivos orales Conclusiones El uso de anticonceptivos orales combinados es muy común, pero se han observado asociaciones con el aumento de la PA y un mayor riesgo cardiovascular en ciertas poblaciones, lo que debe considerarse al prescribirlos y obliga a un seguimiento de la PA en pacientes de mayor riesgo cardiovascular. Es importante equilibrar este riesgo con el peligro que supone un embarazo con HTA no controlada. Con el tiempo, se han desarrollado alternativas que parecen ser más seguras desde el punto de vista cardiovascular para ciertos pacientes, como los anticonceptivos con progestina sola (POPs), los anticonceptivos con estrógenos naturales y progestinas con efectos antimineralocorticoides, como la drospirenona. No obstante, se necesita más evidencia para confirmar esta afirmación. Se recomienda una evaluación exhaustiva antes de prescribir estos medicamentos, así como un control regular de la PA y de los factores de riesgo cardiovasculares en pacientes de alto riesgo. Referencias 1. Cameron NA, et al. Oral contraceptive pills and hypertension: a review of current evidence and recommendations. Hypertension 2023; 80:924–935 2. Cooper DB, et al. Oral contraceptive pills. In: StatPearls. StatPearls Publishing; 2022 3. Kavatar Kalenga CZ, et al. The effect of non-oral hormonal contraceptives on hypertension and blood pressure: A systematic review and meta-analysis. Physiol Rep. 2022;10(9):e15267 4. Nath A, Sitruk-Ware R. Different cardiovascular effects of progestins according to structure and activity. Climacteric 2009; 12:96–101 5. Chasan-Taber L, et al. Prospective study of oral contraceptives and hypertension among women in the United States. Circulation. 1996;94:483–489. doi: 10.1161/01.cir.94.3.483 6. Liu H, Yao J, et al. Association between duration of oral contraceptive use and risk of hypertension: a meta-analysis. J Clin Hypertens 2017; 19:1032– 1041 7. Dong W, et al. Blood pressure in women using oral contraceptives: results from the Health Survey for England 1994. J Hypertens 1997; 15:1063–1068 8. de Souza IS, et al. Association between the use of oral contraceptives and the occurrence of systemic hypertension: A systematic review with statistical comparison between randomized clinical trial interventions. Eur J Obstet Gynecol Reprod Biol X. 2024;22:100307. Epub 2024 Apr 26 9. Kang AK, et al. Effect of oral contraceptives on the renin angiotensin system and renal function. Am J Physiol Regul Integr Comp Physiol 2001; 280:R807–R813 10. Harvey RE, et al. Oral contraceptive use, muscle sympathetic nerve activity, and systemic hemodynamics in young women. Hypertension. 2015;66:590– 597 11. Mulatero P, et al. Angiotensin-converting enzyme and angiotensinogen gene polymorphisms are non-randomly distributed in oral contraceptive-induced hypertension. J Hypertens. 2001;19:713–719 12. Gérard C, et al. Role of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022;15:121–137 13. World Health Organization. (2015). Medical eligibility criteria for contraceptive use, 5th ed. World Health Organization. 14. Nguyen AT, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(4):1. Epub 2024 Aug 8 15. Calculator: Cardiovascular risk assessment in adults (10-year, ACC/AHA 2013) (conventional and SI units). Goff DC Jr, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S49.
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