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

Malignant phase hypertension can occur in women taking combinedoestrogen-progestagen oral contraceptives and is almost certainlycaused by the medication. In previous reports the preparationsused contained 50–100 µg oestrogen. We describefour cases, two of which we believe to be the first recordedexamples of the malignant phase induced by preparations containingonly 30µg of oestrogen. In one case, brain damage dueto over-rapid reduction of very high blood pressure is described. Malignant phase hypertension may occur within weeks of commencingtherapy, or after several years. Although recent preparationscontain lower doses of oestrogen, there is no room for complacencywhen prescribing oral contraceptives. Close medical supervisionand regular blood pressure measurements during such treatmentare mandatory.