2026 Southeastern Residency Conference

Title: Evaluating The Risk of Hypertension Exacerbations in Women Taking Combined Oral Contraceptives with a Pre-Existing Diagnosis of Hypertension
Authors: Taylor Paris, Lisa Ambrose
Background: The purpose of this research is to evaluate the risk of women who are diagnosed with hypertension and are prescribed a combined oral contraceptive (COC) experiencing an exacerbation of their hypertension.  COCs have been shown to cause a modest increase in blood pressure, and their use is generally not recommended in patients with uncontrolled or significant hypertension. However, COCs still continue to be routinely prescribed for women with an existing hypertension diagnosis.
Methods: This single-center, retrospective study aimed to assess the association between combined oral contraceptive (COC) use and hypertensive exacerbations in women with preexisting hypertension. Eligible patients were identified through the electronic health record (EHR) by having an active COC prescription with a concurrent hypertension diagnosis at the time of COC initiation. Chart review was conducted using a standardized abstraction tool that evaluated five criteria: an increase in average blood pressure, an increase in the dose of existing antihypertensive medication(s), initiation of an antihypertensive agent, addition of another antihypertensive to current regimen, and the occurrence of a hypertensive event (i.e. stroke, MI). Binary yes/no responses were for each criterion to determine the presence or absence of hypertensive exacerbation. The goal of this analysis was to quantify the risk of hypertensive exacerbation associated with COC use and inform contraceptive decision‑making in this population.
Results: 14 patients were identified and reviewed within the EHR. 85% of patients met at least one defined criterion, and 64% met two or more criteria. Only 14% of patients did not meet any of the defined criteria. There was a 26% occurrence of 3 of the defined criteria (initiation of BP lowering therapy, dose titration of existing therapy, and increase in average BP reading) and a 22% occurrence of patients requiring addition of another medication. No patients experienced a hypertensive event.
Conclusion: These results suggest that contraceptive options other than COCs may be more appropriate for individuals with established hypertension. The findings highlight the importance of active blood pressure monitoring and medication management to reduce the risk of hypertensive exacerbations within this patient population. Ongoing provider education remains essential to ensure both clinicians and patients can make informed decisions for contraception that account for existing comorbidities.