Long-term blood pressure changes in patients treated with anti-CGRP monoclonal antibodies: A retrospective real-world study

Abstract Background Anti-CGRP monoclonal antibodies (mAbs) used for migraine prevention have raised concerns regarding elevated blood pressure. Existing real-world data come mostly from short observation windows or from cohorts treated with a single antibody. We examined how blood pressure evolves over prolonged treatment across all four available anti-CGRP mAbs. Methods We performed a retrospective real-world study of adults with chronic migraine treated with one of the four anti-CGRP mAbs (erenumab, fremanezumab, galcanezumab, or eptinezumab). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at baseline and during routine follow-up visits. Longitudinal changes in SBP and DBP were analyzed using linear mixed-effects models. Results A total of 133 patients were included, with a median follow-up of 27 months (range 3–72). In the study group as a whole, there was no statistically significant change in SBP (− 0.047 mmHg/month; 95% CI − 0.108 to 0.013; p = 0.135) or DBP (0.006 mmHg/month; 95% CI − 0.040 to 0.051; p = 0.806). Eight patients (7.0%) developed new-onset hypertension during follow-up. Older age was associated with higher SBP, while pre-existing hypertension was associated with higher SBP and DBP. Individual anti-CGRP mAb revealed no statistically significant change in either SBP or DBP over time. Conclusions Anti-CGRP mAb treatment was not associated with a significant change in blood pressure, although new-onset hypertension occurred in a minority of patients underscoring the value of routine BP monitoring during treatment. These findings provide long-term reassurance regarding the blood pressure safety profile of anti-CGRP mAbs.