Kakde Shradha P, Islam Khurram, Ali Muhammad Faizan, Anwar Muhammad Shakaib, Nadeem Laiba, Rana Abdul Rauf, Rana Abdul Wahab, Hayat Sardar Khizar, Ali Syed Momin, Kolanu Nikhil Deep
Medicine and Surgery, Mahatma Gandhi Medical College and Research Institute, Aurangabad, IND.
Internal Medicine, Allied Hospital Faisalabad, Faisalabad, PAK.
Cureus. 2025 Aug 16;17(8):e90244. doi: 10.7759/cureus.90244. eCollection 2025 Aug.
Calcitonin gene-related peptide (CGRP) monoclonal antibodies have emerged as effective preventive treatments for episodic and chronic migraine, but concerns have been raised regarding their potential cardiovascular safety profile, particularly the risk of hypertension. This systematic review aimed to assess the occurrence of hypertension in patients receiving CGRP monoclonal antibodies for migraine prevention. A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library was conducted for studies published between January 2015 and June 2025. Five studies met the inclusion criteria, encompassing 75,065 patients across randomized controlled trials, observational studies, and real-world cohort analyses. The evidence suggests a differential risk profile between CGRP receptor antagonists and ligand-targeting antibodies, with erenumab (receptor antagonist) demonstrating greater blood pressure increases compared to fremanezumab. In patients with baseline hypertension, anti-CGRP treatment was associated with a slight annual increase in antihypertensive medication requirements, while normotensive patients showed minimal blood pressure changes. Clinical trials reported low incidence rates of hypertension adverse events, though post-marketing surveillance identified 362 hypertension events in over 245,000 patient-years of exposure. The temporal pattern suggests cumulative rather than immediate effects, with a small proportion of normotensive patients requiring antihypertensive treatment after erenumab initiation. These findings indicate that while the overall risk of hypertension appears modest, clinically meaningful effects on blood pressure regulation may occur, particularly in patients with pre-existing hypertension. Regular cardiovascular monitoring is recommended for patients receiving CGRP monoclonal antibodies, especially those with baseline cardiovascular risk factors.
降钙素基因相关肽（CGRP）单克隆抗体已成为发作性和慢性偏头痛的有效预防性治疗药物，但人们对其潜在的心血管安全性，尤其是高血压风险表示担忧。本系统评价旨在评估接受CGRP单克隆抗体预防偏头痛的患者中高血压的发生情况。对PubMed、Embase、Scopus和Cochrane图书馆进行了全面检索，以查找2015年1月至2025年6月期间发表的研究。五项研究符合纳入标准，涵盖了随机对照试验、观察性研究和真实世界队列分析中的75065名患者。证据表明，CGRP受体拮抗剂和配体靶向抗体之间的风险特征存在差异，与fremanezumab相比，erenumab（受体拮抗剂）导致的血压升高幅度更大。在基线高血压患者中，抗CGRP治疗与抗高血压药物需求每年略有增加相关，而血压正常的患者血压变化最小。临床试验报告高血压不良事件的发生率较低，尽管上市后监测在超过245000患者年的暴露中发现了362例高血压事件。时间模式表明是累积效应而非即刻效应，一小部分血压正常的患者在开始使用erenumab后需要抗高血压治疗。这些发现表明，虽然高血压的总体风险似乎不大，但可能会对血压调节产生具有临床意义的影响，尤其是在已有高血压的患者中。建议对接受CGRP单克隆抗体治疗的患者进行定期心血管监测，尤其是那些有基线心血管危险因素的患者。
