Malignant hypertension, uremia and hemolytic anemia in a patient on oral contraceptives.

Abstract

A 44-year-old gravida 3 para 3 who was 19 months postpartum and who had been taking norethindrone acetate and ethynyl and estradiol tablets 2 mg for approximately 1.5 years developed malignant hypertension uremia and microangiopathic hemolytic anemia. Autopsy revealed the stigmata of malignant hypertension with widespread arteriolar necrosis fragmentation of the arteriolar wall and thrombosis with recent infarcts in the kidneys and pancreas. A review of the literature shows the association of oral contraceptives with the development of hypertension and in a few cases with malignant hypertension. It is suggested that the blood pressure of patients on oral contraceptives be evaluated periodically and if malignant hypertension develops oral contraceptive treatment should cease.(Authors modified)