A retrospective analysis of postmarketing reports submitted to the FDA Adverse Events Reporting System identified 61 cases of elevated blood pressure associated with erenumab use, of which 41 were considered serious and 7 required hospitalization. Many cases occurred in patients with preexisting hypertension or risk factors for hypertension such as age ≥65 years, dyslipidemia, and diabetes. The median reported increases in systolic and diastolic blood pressure were 39 and 28 mm Hg, respectively. Most cases were associated with the first or second dose of erenumab. Of the 44 cases in which time to onset was reported, 28 occurred ≤7 days after the most recent dose. Hypertension was reported both with and without concurrent triptan use.3 One Medical Letter reviewer reported a case of hypertension that persisted for >3 months after stopping erenumab, even with use of antihypertensive therapy.

In contrast, a retrospective analysis of four randomized, double-blind, placebo-controlled clinical trials including 2443 patients did not finnd an association between erenumab use and hypertension or vascular events; these trials excluded patients who had experienced a serious cardiovascular event in the previous 12 months.4

Eptinezumab-jjmr (Vyepti), fremanezumab-vfrm (Aiovy), and galcanezumab-gnlm (Emgality), the other CGRP antagonists approved by the FDA for migraine prevention, block CGRP itself rather than its receptors. Their labels do not contain warnings about a risk of hypertension. Patients with significant cardiovascular risk factors were also excluded from clinical trials of these agents.5