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Sudden Increase in Blood Pressure: Birth Control Pills or Something Else?

Published on April 1, 2019

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On March 6th, 2019, I went to the podiatrist. When I was in the exam room, the receptionist asked if she could take my blood pressure and weigh me. I said, ‘I’m here for my feet, but okay.’ I was agitated that she was asking for these readings, but I allowed her to take my blood pressure. She said it was 147/117. I said, ‘I have always been ‘120/80.’ She repeated the blood pressure and got another similar reading. I honestly didn’t think anything of it. I figured their cuff needed calibration and she was irritating me with her asking. That evening, I mentioned the high blood pressure result to my husband and he said, ‘Don’t we have a blood pressure cuff in a cabinet somewhere?’ I knew that we did, so we put new batteries in it, fired it up, and wouldn’t you know I got a very high reading–something like 161 over 100-something?!? I took some additional readings and they were all high as well. My husband used the cuff and his blood pressure was 120 something over 80 something. I then knew I had a problem.

I called my primary the next day and asked for an appointment for a physical. I got an appointment for the following week. One of the first things the nurse did was to take my blood pressure and it was 170 over 100 something. The rest of my exam went fine. Later in the visit, primary repeated the blood pressure and it came down, but only to 150 over 100 something. They did an EKG and listened to my heart, which looked/sounded normal. I discussed my current health status: no symptoms of high blood pressure (no blurry vision nor headaches). I had lost about 20 pounds in the past year and was maintaining it. I eat healthy (low carbs, low sugar) and greatly increased my fruit/veggie intake (keto-style diet). I don’t smoke and never have. I don’t use drugs. I exercise about 6 days a week and I honestly am in the best shape of my life: I am 39 years and am 5’5, about 130 pounds. I get good sleep almost every night and don’t feel stressed about work or anything in particular, for that matter. I do drink alcohol, but no more than twice a week (2 nights), when my husband and I go to dinner. The amount of alcohol I consume is a little bit more than my primary likes, but I’ve been on this schedule for a few years now, so he wasn’t that concerned. When I do drink, I drink mainly white or red wine (several glasses).

I have been on birth control pills for 22 years: Ortho Tri Cyclen for about 5 years and then Ortho Tri Cyclen Lo for the rest of the time. From what I understand, Ortho Lo pills have some of the lowest estrogen out there. I did stop the pill a few years ago to see if the extra weight I was carrying was due to taking it (nope!), and had very bad withdrawal effects. I developed terrible acne around my mouth and heavy, unpredictable periods. I went to the dermatologist for the acne, who prescribed an antibiotic, and told me to go back on the pill. I’d guessed I’d be a pill-for-life girl. My ob/gyn at the time liked me on the pill to keep my ovarian cysts small.

Regarding other medications, I take an over the counter allergy pill year-round for seasonal allergies, a multi-vitamin, vitamin D (a physical in the past showed I was low), calcium, an interstitial cystitis medication, and recently started turmeric (a dermatologist recommended this for my skin) and caprylic acid. I read caprylic acid is a good probiotic–as I got C Diff about 6 years ago after taking amoxicillin for a tonsillectomy recovery. I have also had years of antibiotic over-prescription for what my doctors thought were UTIs but were really interstitial cystitis. I had also been taking a liver support supplement.

So back to how I recently lost the 20 pounds: I came upon a ‘hormone balancing center.’ I found them by doing a Google search in March of 2018 when my weight was higher than I wanted. I was so discouraged at this point because I had worked with a personal trainer 2x/week for 9 months previous to no avail. The hormone diet worked for me however! I took their ‘proprietary diet drops’ while reducing my caloric intake for a few weeks, as directed. This process mirrors the HCG diet, which I actually had done a few years back and it worked, but I gained the weight back over the years. I slowly added approved foods back, while greatly reducing sugar and carbs.

Cut to April 2018: I was down the 20 pounds. The hormone center claimed that many women have out of balance hormones, hence the reason for the extra weight. They didn’t necessarily want their customers on the birth control pill, but I wasn’t going to stop it for this diet. I spotted early throughout the diet, which of course, they had never heard of. Keep in mind, they are not medical professionals, only counselors. Their founder is not a doctor. So, after I lost the weight and learned how I should be eating, the center said that I should maintain my weight via their two hormone creams (stress-reduction and progesterone). I was to use one of the creams twice a day for the 3 weeks I was on my active birth control pills and use a progesterone cream once a day for the week I was on the placebo birth control pills. There was some miscommunication with how my counselor told me I should be using the creams for a few months, so I was over-using the progesterone cream. I told her about this and she said that I’d just ‘pee out the excess,’ which I know is not accurate.

I know hormones stay in your fatty tissues for quite some time and aren’t just flushed out. I am in the clinical research/pharmaceutical field and have been for 17 years, so I have learned lots about pharmacokinetics and pharmacodynamics. I also started taking (on my own–not under the direction of the center), some natural ‘diet drops’ that I found online. I didn’t think it would hurt since the ingredients looked natural to me and I felt fine while taking them. They were a lot like the diet drops the center had me take in the beginning of my calorie reduction phase of their diet. By the way, before any of this had started with the blood pressure concerns, it was last checked at my annual ob/gyn exam in May of 2018 and it was 122/79.

I didn’t know that I would be using the creams at the time of my last ob/gyn exam, so I didn’t tell my Ob/Gyn about them. In fact, I hadn’t started them until a few weeks after my visit with her. I had some cosmetic surgery in August of 2018, (this would have been three months on both the creams and the diet drops concomitantly) and my pressures were normal before/during/after surgery. That was the last time my blood pressure was normal. I had no idea all these months that it was high and if it weren’t for the podiatrist, the next time it would be checked would be this May, when I go back to my ob/gyn for my annual exam.

At my recent physical with my primary, he scheduled me for bloodwork and urine (cholesterol, CBC, aldosterone, thyroid), and all of this came back normal and within range. I do not have high sodium nor cholesterol levels. He referred me to a nephrologist, who I see on April 4th. He also scheduled me for an Echocardiogram (April 9th). He also prescribed hydrochlorothiazide: 12.5 mg to be taken once a day in the morning. I started this on 3/26. My blood pressure has been pretty good since I have been taking the medication (120s over 80s). I told my doctor I do not want to be on bp medication and want to know the CAUSE of the high blood pressure. He really thinks one of the supplements I was taking is contaminated since supplements aren’t under FDA scrutiny. I did stop them (except for the bc pill and allergy pill) and the bp was decreasing for several days, but started to increase day by day again.

In summary, I feel that either the diet drops and/or the hormone creams are to blame, since they are the newest additions to my life, since I discovered the high bp, plus the creams stay in my body for awhile, so who knows how long they can linger. I stopped all three of these (creams and drops) since I had my first primary visit. I called my Ob/Gyn (under the direction of my primary) and her advice was to stop the pill (keep in mind she has only met me once for last year’s annual exam–we don’t have a long-standing relationship). I really didn’t want to stop the pill right away–not so much for birth control reasons but for fear of the acne and heavy periods. I should mention that the brand name Ortho Tri Cyclen Lo is unfortunately no longer being manufactured and for the past 2 months I have been forced to take the generic version of this: Tri Lo Marzia–which I am not a big fan of. The formulations of the two pills hormone-wise is the same, but my primary thinks maybe it is something in the binders of the generic which is spiking my blood pressure? It is kind of odd that I ‘change’ the pill (although brand name to generic) and we discover an issue.

Both of my parents had/have high blood pressure, but not until later in their lives. My mother has always been overweight and never exercised and my father smoked most of his life and had poor diet/exercise habits. So, this whole thing is very worrisome to me. I do not have any other health issues, nor have I ever had a health issue. I was especially upset to hear of Luke Perry’s passing at such a young age due to a stroke. I know that the pill increases womens’ risks for clots, but my Ob/Gyns always told me as long as I don’t smoke, I should be fine to take the pill as long as I want. What is going on here? Is it the pill all of a sudden? Is it the switch from the brand name to the generic pill or the two creams from the hormone center? Perhaps it is the diet drops or a contaminated supplement or a weird interaction of any of the above? Or is something wrong with my kidneys and/or heart? I will find out later this month about the kidney and heart status after I see the nephrologist/get the Echo done.

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Matters of the Heart and Birth Control

by Mike Gaskins

Published on July 11, 2017

3355 views

Dr. Ernst Rietzschel described his findings as ‘startling.’ His fellow cardiologists buzzed in agreement after he presented the findings at the American Heart Association 2007 annual meeting. His Ghent University lab in Belgium had discovered that women taking hormonal birth control and those who ever took them for more than a year have an increased risk of atherosclerosis, plaque build-up in their arteries. And, the risk goes up with the duration of use – up to a 42% increased risk with each decade.

This was different from the clotting issues most doctors associated with The Pill. They viewed clotting as a short-term side effect that receded after a woman stopped taking synthetic hormones. However, plaque build-up continues long after a woman stops taking birth control and could ultimately lead to deadly consequences like a stroke or heart attack.

Building Blocks

Ideally, medical research is like a set of building blocks. Each new study builds on the foundation of past experiments. While taking us to a new level of understanding, the new study also provides the foundation for the next layer of discovery that lies ahead.

Dr. Rietzschel’s study contained its own internal set of building blocks. The team initially discovered that women taking hormonal contraceptives had a threefold increase in C-Reactive Protein (CRP) levels. The liver typically increases CRP production in correlation to inflammation levels in the body. Consequently, high CRP levels can act as a marker to indicate the presence of other diseases or conditions.

Dr. Rietzschel explained how this dramatic rise in CRP levels led to discovering the increased risk of atherosclerosis.

“This is the first time that this has been documented. It was an accidental finding. We were stunned by the large elevations in CRP that you see in women taking the pill, so we then performed a safety analysis to see whether there was a link between past pill use and atherosclerosis measured by echo in both the carotid and femoral arteries.”

Single Layer Research

Rietzchel’s results were groundbreaking, but in many ways, his study exemplifies everything that is wrong in medical research related to hormonal birth control. The ideal building-block metaphor has never really materialized. Rather than resembling a pyramid, the blocks making up birth control research look more like someone let their rambunctious four-year old brother into the room. These blocks, scattered in disarray, rarely stack to even a second level.

The investigator accurately described his findings as startling, but even more disturbing is that they were discovered entirely by accident. If CRP levels in the subjects hadn’t been so ridiculously elevated, the researchers might never have considered the link between The Pill and atherosclerosis – despite the fact that the foundation had been laid decades earlier.

With any half-hearted Google search, you can discover that some of the leading factors contributing to atherosclerosis include: high blood pressure, high blood sugar levels, diabetes, and high cholesterol levels. The birth control pill’s contribution to each of these conditions was discussed in depth at the Nelson Pill Hearings in 1970.

Birth Control and High Blood Pressure

Dr. Laragh testified at the hearing that his discovery of the relationship between oral contraceptives and high blood pressure came by chance.

“We observed a woman who we knew had normal blood pressure develop rather severe and impressive hypertension several months after starting an oral contraceptive medication.”

He confirmed this behavior in several other patients and found that, in most cases, the blood pressure returned to normal after stopping The Pill. After they normalized, two patients who had no previous history of high blood pressure requested to continue with birth control pills. In both cases, their hypertension reappeared, and then disappeared upon terminating the medication.

Dr. Laragh stressed that his trial size was too small to have statistical significance, but this ‘rechallenge experiment’ convinced him of a cause and effect relationship. Having also observed that some women ‘swell up and accumulate salt and water,’ he deduced a probable mechanism that could be triggering high blood pressure in birth control patients.

To test his theory, he began measuring certain components of the kidney hormonal system and found that women on birth control experienced enormous increases in renin substrate levels. Renin substrate circulates through the blood and has the capacity to release angiotensin. Dr. Laragh described angiotensin as ‘the hormone which is the most powerful of all hormones in its capacity to raise the blood pressure.’

His suspicions seemed to be confirmed by a 2011 study (40 years later), which found that birth control so significantly elevated angiotensin levels that it could cause false-positive results for aldosteronism.

Another block on the floor…

While addressing the big picture, Dr. Laragh offered a couple of important caveats for the medical industry. First, he strongly recommended that any patient on birth control be seen by the doctor every 2 to 3 months to monitor her blood pressure.

When questioned about such frequent follow-ups, he warned, “We have a responsibility when we have powerful drugs like this; our responsibility is to learn about them, and the second responsibility is to apply the information. Otherwise, we do not have any right to have them on the market.”

Blood Sugar Levels and Diabetes

Further evidence of oral contraceptives’ causal relationship with high blood pressure came in Dr. Philip Corfman’s testimony, when he matter-of-factly stated, “It is known that steroids alter the diameter of veins and other blood vessels. These effects are also related to the changes in blood pressure observed in some users of oral contraceptives. Several reports of hypertension have appeared and there is an increasing body of evidence that there may be a positive relationship.”

Dr. Corfman had previously headed a task for at the National Institutes of Health. His team combed through nearly 4,000 journal articles and sorted the concerns into more than 20 categories that they felt needed further attention. Much of his testimony focused on birth control’s metabolic effects on the body, particularly how the synthetic hormones modified carbohydrate metabolism.

“Recent investigations show that a significant proportion of normal women on these agents appear to handle sugar in an abnormal way.” He continued, “Another biologic change of increasing concern is the effect on the way the body handles fat. This effect is closely related to changes in sugar metabolism since fat synthesis is related to insulin levels. The changes which have been observed in fat metabolism simulate levels seen in older individuals and raise concern over the possibility that these alterations may be related to heart disease.”

And this was no rare event, Dr. Victor Wynn testified that nearly 1-in-5 young women taking The Pill developed an abnormal glucose tolerance that he named “chemical diabetes.”

The Pill and High Cholesterol

Recognizing that there were also abnormalities in the fats circulating in the blood of birth control patients, Dr. Wynn decided to measure triglycerides against a control group. He discovered that “at least one-third of the users had triglyceride values higher than the highest value we found in our control subjects.” Let that sink in – the woman with the very highest triglyceride values from the control group had numbers lower than one-third of the women on The Pill.

In his beautiful British accent, Dr. Wynn slyly added, “I am sure that there is no need for me to tell an American audience the significance of having your cholesterol levels elevated, since there is so much propaganda in the press, medical, and lay, indicating the importance of having your cholesterol lower, if you can possibly achieve it.”

In order to demonstrate the domino effect of these complications, Dr. Wynn submitted a summary of over 70 references taken from medical literature over the previous 3 years.

“It is by no means exhaustive. But the references are to the association between abnormal glucose metabolism, abnormal insulin levels, and abnormal blood lipid or blood fat levels, and the accelerated development of atherosclerosis.”

More blocks on the floor…

Don’t Discount Clotting

World-renowned neurosurgeon, Dr. David Clark testified that the strokes young women on birth control encountered were different than those seen in older patients. The Pill seemed to trigger a different mechanism, as ‘alterations in the normal clotting behavior are certainly present.’

“There is some reason also to believe that there may be changes in the vascular wall itself. It is known that estrogens have an effect on the caliber of veins. In some of the stroke victims who have been studied, there is a peculiar beaded appearance to the walls of the arteries -– not occlusion, but irregularity of outline that suggests there may be edema or other changes in the outer wall of the artery.”

Dr. Wynn added, “When you see the abnormalities, these are associated in some curious way with increased incidence of clotting, so that putting the two together, I think it is a reasonable case, but it cannot be proved, and this underlines the great difficulty we have with the contraceptives, that what harm they may do may never in fact be proved.”

At the rate we’re going, it will certainly never be proved.

Second Level Stuff

However, there is a seed of hope on at least one front.

Some practicing cardiologists have noticed the long term effects of birth control on their patients and they’ve begun to talk about it.

After his study that uncovered the startling link to atherosclerosis, Dr. Rietzschel told Medscape:

“I’m certainly not advocating stopping use of the pill,” he noted. First, the findings need to be replicated, “that’s really important,” he said, “and then we need more research. It’s staggering that for a drug that is being used by 80% of women, there is so little information about the long-term safety. That’s really incredible.”

It is very common for the lead investigator of a negative study to make statements like “This doesn’t mean women should stop taking The Pill” and “Certainly more research needs to be done,” I suppose in an attempt to appease pharmaceutical companies. But Dr. Rietzchel’s statements were different. You could sense his genuine dismay that so little has been done to understand the safety of hormonal contraceptives.

This prompted me to contact Dr. Rietzschel to see if he was aware of any subsequent studies building on his atherosclerosis findings (10 years have lapsed since its publication). It turns out, his team is in the final stages of a longitudinal study, and he expects the analysis to be published within the next year.

This is a promising development. Let’s just hope no one let’s their four-year old brother into the room.

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