The Effect of Intravitreal Ranibizumab Injection on Systemic Blood Pressure: A Prospective Study

Introduction: Hypertension is a common disease, which may be induced or precipitated by antivascular endothelial growth factor therapy with many studies reporting this complication of this therapy. Methods: This is a prospective study to evaluate blood pressure changes in normotensive, controlled and uncontrolled hypertensive patients on regular medical treatment after a 0.05 ml (0.5 mg) intravitreal Ranibizumab injection. It was held in Ibn-alhaitham eye teaching hospital in Baghdad between May 2019 and December 2019. It included patients with variable retinal diseases receiving either unilateral or bilateral intravitreal Ranibizumab injections, their blood pressure was measured before the treatment as a baseline, and then 2 hours, 1 month, and at 3 months from the first injection(s). These were allocated to three groups; Group A included normotensive patients without history of hypertension; Group B included controlled hypertensives and those with grade 1 hypertension with antihypertensive treatment. Group C included those with Grade 2 hypertension or more with antihypertensive treatment. Blood pressure was measured in all patients using the manual sphygmomanometer in sitting position. Paired t-test was used to analyze blood pressure measurements and compare mean arterial, systolic and diastolic pressure. A P-value of ≤ 0.05 was considered significant, and a P-value of ≤ 0.001 was considered highly significant. Results: Seventy-five patients (n=75) were included in the study with a mean age of 59.1 ± 11.4 years 58.7% males and 41.3% females, 44% were controlled-hypertensives, 26.7% were uncontrolled-hypertensives, 29.3% were normotensives. Group C showed highly significant reduction in the mean arterial, and systolic pressures in all three measurements after baseline (P ≤ 0.001), and significant reduction of diastolic blood pressure at one and three months after baseline (P ≤ 0.05). Both groups A and B showed a reduction in most measurements, but most were statistically insignificant (P ≥ 0.05). Unilateral and bilateral injection groups showed similar reduction in the mean arterial pressure at 2 hours and 3 months (P ≤ 0.05), mean systolic blood pressure was reduced in unilateral group in all 3 measurements (P ≤ 0.05, P ≤ 0.05, P ≤ 0.001, respectively) and also in the bilateral group at 2 hours and 3 months (P ≤ 0.001, P ≤ 0.05 respectively), and mean diastolic blood pressure was reduced at 2 hours in the unilateral group (P ≤ 0.05), and at 3 months in the bilateral injection group (P ≤ 0.05). Conclusion: There is an overall reduction of blood pressure with Ranibizumab Intravitreal injections especially in the moderate to severely uncontrolled hypertensive patients, while controlled-hypertensive, mildly uncontrolled hypertensive showed statistically insignificant changes which indicates that, it is acceptable to continue using Ranibizumab in both normotensive and hypertensive patients in the short term.