Immediate changes in blood pressure during intravitreal anti-VEGF agents' applications in exudative age-related macular degeneration patients

Abstract

Purpose To determine the short-term changes in systemic arterial blood pressure (SABP) during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in patients with exudative agerelated macular degeneration (ARMD).Materials and methods This study retrospectively reviewed the data of 550 patients with exudative ARMD, who received intravitreal anti-VEGF (bevacizumab or ranibizumab; selected randomly) injections. Patients with hypertension on medication with antihypertensive drugs were assigned to the hypertension group (HTG; n = 278); those with normal blood pressure and not on antihypertensive drugs were assigned to the normotensive group (NTG; n = 272). The SABP levels were measured 30 min before anti-VEGF injection (baseline = B), during anti-VEGF injection (DI), as well as 30th (I30) and 60th (I60) min after anti-VEGF injection. Results Both groups had significantly higher systolic blood pressure (SBP) at DI than that of the baseline values (p \ 0.001), whereas the diastolic blood pressures (DBP) increased significantly at DI, I30, and I60 compared with baseline (p \ 0.001). In NTG, SBP was significantly higher in patients at I30 (p = 0.019), whereas that in HTG was significantly higher at all measurements (p \ 0.05) only in patients who received intravitreal bevacizumab injection. Conclusion Our study results show that intravitreal anti-VEGF injection is associated with a short-term increase in SABP. To prevent potential systemic complications during anti-VEGF administration, the systemic status of patients with ARMD should be evaluated before the injection and those with a risk of high SABP during injection should be closely monitored.

Is perioperative blood pressure monitoring during intravitreal injections important?

“…Similarly, Berger et al 17 found age to be associated with an SBP > 200 mmHg during the injection. Balci et al 19 reported that intra-procedural rise in SBP was higher in hypertensive patients compared with normotensive ones. However, we could not find such an association.…”

Cardiovascular and Cerebrovascular Safety of Ranibizumab, Bevacizumab, and Aflibercept in Ocular Diseases: An Analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) Database

“…From the present study, both ranibizumab and bevacizumab were associated with hypertension. One study showed that systolic blood pressure was higher in patients receiving bevacizumab than in those receiving ranibizumab 30 minutes after the drug injection 33 . Several investigations of vitreous injections of anti‐VEGF have shown that hypertension increases the risk of various complications, although such elevated blood pressure may be transient 14 .…”

“…One study showed that systolic blood pressure was higher in patients receiving bevacizumab than in those receiving ranibizumab 30 minutes after the drug injection. 33 Several investigations of vitreous injections of anti-VEGF have shown that hypertension increases the risk of various complications, although such elevated blood pressure may be transient. 14 Therefore, it is necessary to monitor blood pressure throughout the dosing period, especially during injections, when there may be an additional risk of elevated blood pressure due to patient fear and anxiety.…”

Direct evidence of VEGF-mediated neuroregulation and afferent explanation of blood pressure dysregulation during angiogenic therapy

“…Vascular endothelial growth factor (VEGF) plays an important role in anti-angiogenic cancer therapy [1][2][3], but this clinical management can cause significant cardiovascular toxicity [4][5][6], such as hypertension [6][7] during the course of treatment. This observation has emerged as a hot topic in the field of oncocardiology which aims to retain the maximum therapeutic efficacy for cancers while minimizing adverse cardiovascular effects [8].…”