In predisposed women, the use of the contraceptive pill can cause a slight increase in blood pressure, both as regards the maximum values (systolic) and as regards the minimum ones (diastolic). In the most serious, fortunately minority cases, the pressure increase can be such as to make the woman hypertensive (> 140/90 mmHg).
The risk of suffering from high blood pressure associated with the use of the contraceptive pill is higher in obese women over the age of 35, who have suffered pregnancy-prone hypertension, kidney disease and a family history of high blood pressure.
Regardless of blood pressure, smoking dramatically increases the risk of cardiovascular complications associated with the use of the contraceptive pill. It should be avoided in those who want to use the pill, or other hormonal contraceptives, including those with hypotensive effect (drospirenone).
Contraceptive therapies may contain synthetic derivatives of estrogens and progesterone, or only the latter. The risk of suffering significant increases in blood pressure seems to be greater for the former, but some studies point to slight increases in the diastolic blood pressure even in some women who use the so-called minipillola (progestin), which is, however, charged with worsening the lipidemic profile of those who take it . Some recently introduced contraceptives, such as drospirenone, can also be used in cases of hypertension (which until recently was a contraindication to the use of traditional contraceptive pills).
Drospirenone is a synthetic progestin with an action analogous to spironolactone (it is a mild diuretic); therefore, its use is not only separated from any increase in blood pressure, but also exerts a protective action on the front of high blood pressure.
The current availability of various types of hormonal contraceptives, with different and constantly updated indications, allows the gynecologist to personalize the choice based on the contraceptive needs of the woman and her state of health. Also drospirenone, to cite an example, has a not negligible list of contraindications and potential side effects.