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F. Q. Esmail, R. Radhakrishnan, R. M. Lieberman, R. M. Fischer; The Effect of Intravitreal Bevacizumab (Avastin®) on Systemic Blood Pressure. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5614. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal bevacizumab (Avastin®) has multiple systemic effects. We examined the effects of intravitreal Avastin (IVA) on systemic blood pressure.
A retrospective analysis was performed on patients receiving IVA from 11/06 to 11/07. Data includes medical history, indications for injection, and systolic/diastolic blood pressure (SBP/DBP) prior to (Pr), within 20 minutes of (immediate post injection, IPI), and 24 hours post injection (delayed post injection, DPI).
A cross sectional cohort of 65 patients (88 eyes) was included; with 42 males and 23 females, ages 25 to 84. Fifty-four were hypertensive, 62 were diabetic, and 9 had renal failure (CRF).In the nonhypertensive group, Pr mean SBP/DBP was 143/79 (range 105-187/64-100). IPI mean SBP/DBP was 136/77 (range 109-173/62-100) and DPI mean SBP/DBP was 141/80 (range 106-171/67-92). No difference was found between Pr, IPI, and DPI BPs, and no adverse effects were recorded for this patient group.In the hypertensive group, Pr mean SBP/DBP was 141/77 (range 68-205/46-100). IPI mean SBP/DBP was 153/82 (range 106-230/60-121) and DPI mean SBP/DBP was 144/79 (range 106-211/61-103). T-test analysis showed statistical significance between Pr and IPI BPs. One patient in the hypertensive group suffered a CVA 1 month post injection.The hypertensive patients were also sub-grouped according severity/control of HTN and renal function. T-test showed statistical difference between Pr and IPI BPs in patients with Pr SBPs <120, 120-139, and 140-159, but none in patients with SBP>160. The CRF group showed a significant relationship between Pr and IPI DBP. Administering multiple IVAs did not affect BP during the study.
There was no statistical significance between Pr and DPI BPs in any group. However, the hypertensive group had a statistically significant increase in IPI BP, while the non-hypertensive group did not. Within the hypertensive group, there was a statistically significant difference between Pr and IPI BPs in patients whose baseline SBPs were less than 160, and in the Pr and IPI DBP of CRF patients. No long-term correlation was found between Pr BPs in patients receiving multiple injections. Although the hypertensive group appears more susceptible to additional rise in BP, it is unknown whether this is secondary to the procedure or the medication. Further studies will be important to determine the long-term sequela of IVA on BP, and to identify those patients in whom medical management may be indicated.
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