A small percentage of people developed symptomatic hypertension minutes after getting a COVID-19 vaccine, according to a case series from Switzerland.
Out of the first 12,349 people to get vaccinated at one hospital, nine people experienced symptoms — including malaise, headache, chest pain, sweating, and anxiety — soon after getting their mRNA vaccine.
Oscillometric measurements suggested hypertension, with blood pressure (BP) rising as high as 220/102 mm Hg. Clinicians had measured BP three times at 5-minute intervals, reported a group led by Sylvain Meylan, MD, PhD, of Lausanne University Hospital, Switzerland, in Hypertension.
All patients recovered, but six people spent a few hours undergoing monitoring and treatment at the emergency department (ED).
“The mRNA vaccines have received intense scrutiny for immediate hypersensitivity reactions in the wake of an initial report signaling 21 cases [of] anaphylaxis. Hypertension, on the other hand, has not been mentioned explicitly as an adverse event in both safety/immunogenicity trials,” the authors noted.
Clinical trials for the vaccines included predominantly younger participants, in contrast to the older individuals who were among the first vaccinated in the real world.
“Although more data are needed to understand the extent and the mechanism of hypertension after mRNA-based vaccination, our data indicate that in elderly patients with a history of hypertension and/or significant prior cardiovascular comorbidities, pre-vaccination control of BP and post-vaccination monitoring, including symptom screening may be warranted,” Meylan and colleagues suggested.
Yet changing practice based on this case series alone would be too hasty, given that there were no pre-vaccination BP data and no clear mechanism for why someone would suddenly become hypertensive after receiving a vaccine, said Jordana Cohen, MD, MSCE, of University of Pennsylvania in Philadelphia.
“I am a huge proponent of working to better control BP whenever given the opportunity in order to prevent long-term risks of heart, kidney, and brain damage from chronically elevated BPs. However, I do not think that a case series of nine patients, amidst the tens of millions who have already been vaccinated, merits a change in practice without further data,” she told MedPage Today.
“I think that we would be placing undue additional risk on these patients, who are at very high risk of acute adverse outcomes from COVID-19, if we delay vaccination to work to better control BP, which is a process that often takes weeks to months to appropriately achieve,” she continued.
Cohen urged further systematic evaluation, based on international post-vaccination reporting, before raising the alarm on a potential link between COVID vaccination and hypertension.
The nine patients (seven women and two men) ranged in age from 55 to 88 years (median age 73 years). Eight people had a prior history of arterial hypertension, with six reporting use of blood pressure medication.
After transfer to the ED, imaging was performed on one patient with a prior history of coiled vascular aneurysm who developed a headache after vaccination, but showed no signs of intracranial hemorrhage.
The individual reporting chest pain did not have associated electrocardiogram changes or an increase in hs-troponins to suggest acute coronary syndrome.
One person was deemed to have white-coat hypertension (at 168/115 mm Hg) and did not require treatment.
“From the data shared, it is reassuring that the increase in BP was not associated with effects on other organs,” commented Nadine Rouphael, MD, of the Hope Clinic at Emory University School of Medicine in Atlanta, who has conducted vaccine studies for Moderna and currently serves as the international co-chair for the Sanofi protein vaccine.
Nevertheless, “continuous monitoring of the safety of the COVID-19 vaccines is paramount,” she said.
Eight of the nine hypertensive individuals in the case series had received the Pfizer/BioNTech vaccine. Only one received the Moderna shot.
“Our case series suggests that a fraction of hypertensive patients may react with symptomatically significant increases in both systolic and diastolic BP. A stress response is likely in view of the public debate, in addition to pain response and white coat effect, the latter being associated with age and female sex,” Meylan and colleagues wrote.
“However, the relatively low heart rate (median 73 beats per minute) may soften this hypothesis. Alternative mechanisms could theoretically include hypertension to components of the vaccines such as polyethylenglycol, although this seems unlikely due to the presumably low dosage and as patients reacted within minutes of the injection,” they added.
Meylan’s group had no disclosures.
Cohen reported receiving NIH funding.