The birth control pill may be safely prescribed to women with pre-existing high blood pressure, but it is important for many reasons that the blood pressure be monitored and well-controlled.

BCPs occasionally aggravate pre-existing high blood pressure.

If this happens, switching to a different pill will sometimes solve the problem. If switching fails to resolve the problem, then usually the BCP will need to be stopped.

In the olden days (40 years ago), it was commonly believed that BCPs would routinely increase blood pressure, and our experience with “sequential” birth control pills supported that view. But the sequential pills have not been in clinical use for a long time, and today, it is rare to find an individual whose blood pressure becomes elevated as a result of low dose combination BCPs.

Whenever blood pressure elevations are found among women on BCPs, it is usually found that these women have underlying hypertension. The pill didn’t cause the hypertension, but rather the increased blood pressure scrutiny associated with prescribing BCPs uncovered a problem that no one knew was there.

Among these patients, they may safely use BCPs so long as it does not make the hypertension worse. Usually, it makes it better, because the suppression of ovarian function leads to lower and more stable circulating hormone levels. At the same time, if the particular pill is not suppressing ovulation (clinically noted by heavier, lengthier, crampier periods) then that patient will be experiencing higher hormone levels, not conducive to good blood pressure control.

With or without the birth control pill, hypertension needs to be controlled.