Medical Eligibility Criteria & Hypertension

Question: 

Hi, I coordinate our youth program and  I have had some of the nurses needing further clarification on hypertension. If the client presents with hypertension at their visit, is that considered forever or can we re-evaluate at a different time to reassess. This came up with the last update on migraines and wondering if the scenarios are similar.
Thank you
E

Answer:

Let’s first look at what category the MEC classifies Hypertension:

For all categories of hypertension the MEC states CHC are a category 3 or 4 – the risks outweigh the benefits. However the MMWR does provide some clarifications:

  • For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. When multiple risk factors do exist, risk for cardiovascular disease might increase substantially.
  • Women adequately treated for hypertension are at reduced risk for acute myocardial infarction and stroke compared with untreated women. Although no data exist, CHC users with adequately controlled and monitored hypertension should be at reduced risk for acute myocardial infarction and stroke compared with untreated hypertensive CHC users. Evidence: Among women with hypertension, COC users were at higher risk than nonusers for stroke, acute myocardial infarction, and peripheral arterial disease.
  • Discontinuation of COCs in women with hypertension
  • A single reading of blood pressure level is not sufficient to classify a woman as hypertensive. (MMWR July 2016, p.21)

What does this mean for practice:

  • A thorough history of the patient’s hypertension is warranted
  • Is the hypertension current?
  • Is the patient on medication? (i.e. well controlled = MEC 3)
  • Was the hypertensive episode a one off?
  • If the patient is no longer hypertensive and not requiring medicine should they be classified as hypertensive?

Back to the original question – the MMWR does not indicate that history only should be a restriction for CHC use – therefore if the patient is no longer on medication (this would be well controlled and still a MEC 3) and is not hypertensive consider discussing alternate options for contraception. If she still chooses COCs ensure you counsel her on risks. If the patient is currently hypertensive and wants COCs a referral must be made.