Malignant hypertension and oral contraceptives: four cases, with two due to the 30 ug oestrogen pill

Malignant phase hypertension can occur in women taking combined oestrogen-progestagen oral contraceptives and is almost certainly caused by the medication. In previous reports the preparations used contained 50–100 μg oestrogen. We describe four cases, two of which we believe to be the first recorded examples of the malignant phase induced by preparations containing only 30μg of oestrogen. In one case, brain damage due to over-rapid reduction of very high blood pressure is described. Malignant phase hypertension may occur within weeks of commencing therapy, or after several years. Although recent preparations contain lower doses of oestrogen, there is no room for complacency when prescribing oral contraceptives. Close medical supervision and regular blood pressure measurements during such treatment are mandatory.