Abstract Details

Title Risk Stratification of Hypertension Induced by CGRP Antagonist in Migraine Treatment: A Retrospective Observational Analysis

Topic Headache

Presentation(s) S23 - Hot Topics in Headache Medicine (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective

To compare incidence of hypertension across different CGRP antagonist agents and effect of comorbidities in response to emerging post-market safety signals.

Background Advancements in research and understanding of migraine have led to the development of targeted Calcitonin Gene-Related Peptide (CGRP) antagonists as both preventive and abortive therapies. CGRP is a potent vasodilator, and its inhibition may lead to vasoconstriction and increased vascular resistance, thereby contributing to elevated blood pressure. With the growing use of the Gpant class of drugs and other CGRP inhibitors in clinical settings, it is critical to determine which populations are most at risk for developing this side effect.

Design/Methods

250 patients prescribed any CGRP antagonist, including erenumab, fremanezumab, galcanezumab, eptinezumab, and the gepants (ubrogepant, rimegepant, atogepant, zavegepant).
Variables extracted included: age at start, sex, and body mass index (BMI). Comorbidities: pre-existing hypertension, diabetes, chronic kidney disease, stroke, and obstructive sleep apnea (OSA); OSA treatment status (treated vs untreated) was noted.

Results Among 149 adults initiating CGRP antagonist therapy, 93 % developed new-onset hypertension within 6 months, typically within the first month (median = 1 month). Incidence was comparable across erenumab, gepants, and other mAbs. Logistic regression revealed no significant associations with age, sex, BMI, baseline BP, or OSA status. Among patients with OSA, treatment status did not significantly modify risk. Hypertension was persistent in 82 % of cases and transient in 8 %, indicating sustained BP elevation. The Kaplan–Meier curve confirmed an early onset window (1–3 months) without progressive late-onset risk across drug classes.

Conclusions Hypertension following CGRP initiation is an early event, occurring within the first few months.Once developed, hypertension tends to persist, with no new cases after 3 months. The pattern is similar across drug classes, indicating that risk is likely related to the CGRP pathway blockade rather than a specific molecule.

Authors/Disclosures
Suresh Kumar, MD (Neurology & Headache Center) PRESENTER	Dr. Kumar has nothing to disclose.
Anbu M. Subramanian	Mr. Subramanian has nothing to disclose.
Maya Salimath, Undergrad	Miss Salimath has received personal compensation for serving as an employee of Quartino Chicago.
Sahith S. Abraham	Mr. Abraham has nothing to disclose.
Amrith Sundar Sankar	Mr. Sankar has nothing to disclose.
Ayan R. Patel, MD	Dr. Patel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eidos. Dr. Patel has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Dr. Patel has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Patel has received research support from Astra Zeneca. Dr. Patel has received publishing royalties from a publication relating to health care. Dr. Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Echo Core Lab consultant with Cardiovascular Clinical Sciences.
Mahith Ravulapati	Mr. Ravulapati has nothing to disclose.
Hanna Sameer (Young Scientist of America)	No disclosure on file

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