Applied Pharmacotherapy

CASE 7
 Case 7

Mrs. SS(35 years old) came to a drugstore to find microgynon tablets.

The patient has been using microgynon for 5 years. Since 6 months
ago she has been diagnosed for a stage I hypertension.

PROBLEM:
1. Using microgynon
2. Hypertension
 Definition of Hypertension

Hypertension : Elevation of blood pressure persistently over 140 mmHg

SBP and 90 mmHg DBP (DiPiro, 1988)

Classification Systolic (mmHg) Diastolic (mmHg)

Normal < 120 < 80
Prehypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 160 99

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Pathophysiology of Hypertension

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 Risk Factor of Hypertension

Risk factor
1.Age
2.Alcohol
3.High sodium intake
4.Smoking
5.Diabetic Drug induce:
6.Hyperlipidemia The use of microgynon
7.Family history (genetic) - levonorgestrel
8.Gender - ethynil estradiol

9.Drug induce
 Mechanism of Microgynon-induced
Hypertension
Based on 24 studies including 270,284
participants, a positive association was found
between duration of oral contraceptive (OC)
use and risk of hypertension.
duration of oral contraceptive use risk of
hypertension
risk of hypertension increased by 13% for
every 5-year increment in oral contraceptive
use

The risk of hypertension is higher on women

who used OC and at 35 years old or >
(Liu et al., JURNALNYA EDISI VOLUME 2017)
 Therapeutic Goal of The Case

Increase patient knowledge:

microgynon (ethinyl estradiol,)-induced hypertension
Improve patient quality of life:
1. decrease blood pressure and the risk factor
2.provide comfort to the patient (giving recommendation
about contraception)
 Standard Therapy of Hypertension

DiPiro (1988):
First line of hypertension therapy:
ACEI, ARB, CCB or diuretics

Amlodipin is more effective to reduce BP than ACEI (Lacourcire

et al., 1993)
 Medication

1. Give information to the patient about microgynon-induced

hypertension
2. Suggest to change microgynon to nonhormonal contraceptive
3. Suggest patient to see physician and discuss about her
medication (choose contraception and antihypertensive)

All of the medication should be taken after consultation with

physician
Non Pharmacology Therapy of Hypertension

1. Manage body weight,

2. Adoption of the Dietary Approaches to Stop Hypertension
(DASH) eating plan,
3. Dietary sodium restriction ideally to 1.5 g/day (3.8 g/day
sodium chloride),
4. Regular aerobic physical activity