Intravitreal injection linked to substantial temporary blood pressure increase
medwireNews: Patients undergoing intravitreal injections with anti–vascular endothelial growth factor agents can experience substantial transient increases in systolic blood pressure, Swiss researchers report.
According to Martin Zinkernagel (University Hospital Bern) and colleagues, around one in 10 of the 201 patients (mean age 68 years, 46% women) undergoing intravitreal injections at a single centre over a 4-month period experienced a systolic blood pressure rise to greater than 200 mmHg during injection.
“Because systolic blood pressure can become substantially elevated during intravitreal injections, future work may be needed to determine whether, in patients at risk for cardiovascular or cerebrovascular events, perioperative blood pressure monitoring or antihypertensive therapy needs to be considered,” they write in JAMA Ophthalmology.
The researchers found that mean systolic blood pressure increased significantly during the injection process from a baseline of 150 mmHg to 162 mmHg following the preparation procedure and then to 168 mmHg during the injection. Following injection it fell to 157 mmHg, but was still significantly higher than at baseline.
Significant increases were also seen in diastolic blood pressure, rising from 78 mmHg at baseline to 83 mmHg both after preparation and during injection, then falling to 82 mmHg following injection.
The researchers note that 144 (72%) patients experienced a systolic blood pressure rise of at least 10 mmHg and 93 (46%) had an increase of at least 20 mmHg.
Moreover, 23 (11%) patients had a systolic blood pressure greater than 200 mmHg during injection. The mean increase from baseline in this group was 32 mmHg (182 to 214 mmHg) and was significantly higher than the mean 16 mmHg increase observed among individuals with systolic blood pressures below 200 mmHg.
Mean pulse frequency also increased significantly from 76 bpm at baseline to 80 bpm during injection, but there was no change in oxygen saturation throughout the procedure.
Interestingly, Zinkernagel and team report that there was no significant association between baseline systolic blood pressure and blood pressure rise during injection, but there was a significant association with age and discomfort after the last injection.
The investigators point out that most of the blood pressure rise occurred “following the preparation before the injection itself.”
They conclude: “This may constitute a risk factor for cardiovascular or cerebrovascular complications during treatment and could be of particular relevance in patients at high risk for such events and those receiving frequent injections.”
By Laura Cowen
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