OBJECTIVES: Hypertension (HTN) with blood pressure (BP) levels ≥ 140/90 mmHg is classified as a category 3/4 contraindication for the initiation of combined hormonal contraceptive (CHC) according to the US Medical Eligiblity Criteria (USMEC) for Contraceptive Use, indicating that CHC risks outweigh the advantages (USMEC 3) or are unacceptable to patient health (USMEC 4). This study aims to describe the prevalence of hypertension and BP levels in women initiating a CHC.

METHODS: This cross-sectional study included women from the Oracle EHR Real World Data, aged 18-55 years and initiating a CHC between 2021-2023. HTN status was determined with the presence of at least 2 ICD-10 codes for HTN or BP measurements ≥120/80 mm Hg during 2 years prior to CHC initiation. Well-controlled HTN was defined as the closest BP measurement prior to initiation < 140/90 mmHg. Recommendations for contraceptive use were assessed according to the USMEC and the American College of Obstetricians and Gynecologists (ACOG).

RESULTS: A total of 554,410 women initiated CHC among which 15% had HTN (n=82,838), with a mean age of 32.9 [9.1] years. Among women with HTN, 41% (33,790) were well-controlled and aged ≤ 35 years (USMEC category 2) and 24% (n= 20,126) were well-controlled and aged > 35 years (USMEC category 3). SPB 140-159 or DBP 90-99 mmHG was found in 8% (n= 6,752) of women with HTN (USMEC category 3) and 2% (n= 1,362) had BP ≥ 160/100 mmHG (USMEC category 4). A second cardiovascular risk factor (USMEC category 3/4) was present in 58% of women (n= 47,774) with obesity and diabetes being the most represented (54% and 6%, respectively).

CONCLUSIONS: Despite the recommendations for proper assessment prior to CHC prescription, the prevalence of HTN among CHC initiators remains high, with a notable proportion of patients for whom CHC should be avoided or is contraindicated.