The Change in Endothelial Damage and Vascular Endothelial Growth Factor An Index of Angiogenesis, following Intensified Blood Pressure Treatment in High-Risk Hypertensives

Abstract Background and Aims Intravenous (IV) anti-vascular endothelial growth factor(VEGF) is a potent anti-angiogenic factor for the treatment of solid tumours. While, intravitreal anti-VEGF injection is used in the treatment for macular and retinal diseases. The effects of IV anti-VEGF agents are well documented to cause hypertension, renal impairment and proteinuria. However only few reports showed the significance of intravitreal anti-VEGF injection causing minimal change disease (MCD) and acute kidney injury (AKI). Hence, this study is to determine the outcome of renal function following intravitreal anti-VEGF injection. Method This is a prospective, cross sectional study recruiting patients from ophthalmology day-care operation theatre that were scheduled for intravitreal anti-VEGF injection in University Malaya Medical Centre (UMMC). On the day of the injection of anti-VEGF, patients’ demographic data (age, gender, medical background, medications), blood pressure, height, weight and investigations for serum creatinine and urine protein creatinine ratio (PCR) were collected. Following these, they will receive the intravitreal anti-VEGF as per schedule. All these patients were given a follow-up within 72hours to reassess blood pressure, serum creatinine and urine PCR. Results A total of 90 patients were recruited. However, 15 patients were subsequently excluded as there was no repeated serum creatinine at 72-hours post treatment. Their mean age was 67.25 ± 10.41. Among all, 3 patients had significance increased in serum creatinine (4%) with significance changed of urine PCR post treatment. Table 1 showed baseline parameters prior to treatment and table 2 was post treatment parameters. Higher serum creatinine and proteinuria pre intravitreal anti-VEGF were identified to have higher OR of 1.018 (95% CI 1.001-1.035) (p=0.043) and OR 1.004 (1.000-1.007) (p=0.025) respectively among those who developed AKI. In assessing the association between higher pre-treatment creatinine and proteinuria (independent variable) and development of AKI (dependent variable) estimated by logistic regression with no AKI as a reference group we found that there were no significance. Conclusion Following intravitreal anti-VEGF administration, there were no significant changes in blood pressure. However, 4% from our cohort had AKI and worsening proteinuria at 72 hours post treatment. These patients had higher serum creatinine and proteinuria prior to treatment. However, our study is underpowered to establish the relationship between intravitreal anti-VEGF and development of AKI. Further study with larger sample size and longer-term outcome is needed.

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Vascular Endothelial Growth Factor Receptor 2 Controls Blood Pressure by Regulating Nitric Oxide Synthase Expression

Hypertension ◽

10.1161/hypertensionaha.109.129973 ◽

2009 ◽

Vol 54 (3) ◽

pp. 652-658 ◽

Cited By ~ 180

Author(s):

Carie S. Facemire ◽

Andrew B. Nixon ◽

Robert Griffiths ◽

Herbert Hurwitz ◽

Thomas M. Coffman

Keyword(s):

Nitric Oxide ◽

Blood Pressure ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Nitric Oxide Synthase ◽

Growth Factor Receptor ◽

Vascular Endothelial ◽

Oxide Synthase ◽

Endothelial Growth Factor

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Recurrent Blood Pressure Rise after Treatment with Anti-vascular Endothelial Growth Factor Agents

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1081-1635 ◽

2020 ◽

Vol 237 (04) ◽

pp. 454-457

Author(s):

Iris Wyssmüller ◽

Karen Schaal ◽

Sebastian Wolf ◽

Martin Zinkernagel

Keyword(s):

Blood Pressure ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Pressure Increase ◽

Vascular Endothelial ◽

Blood Pressure Increase ◽

Injection Process ◽

Endothelial Growth Factor

Abstract Background It has previously been shown that the process of anti-vascular endothelial growth factor (VEGF) injections can lead to a significant increase of blood pressure. The aim of this study was to investigate whether this blood pressure increase was reproducible with repeated anti-VEGF injections. Patients and Methods Patients with a systolic blood pressure of ≥ 180 mmHg during previous injections who were scheduled for further injections were asked to participate in this study. Systolic as well as diastolic blood pressure was measured before, during, and after the intravitreal injection process. Results Thirty-nine patients (21 females, 18 males) with a mean age of 75 years (range 34 – 94 years) were included in this extension of the FEAR study. At first, clinical systolic blood pressure rose from an average of 157.3 ± 5.9 mmHg to 175 ± 6.7 mmHg at the time of the injection process (p < 0.01). Diastolic blood pressure rose from an average of 75.72 ± 4.2 mmHg to 84.44 ± 7.3 mmHg (p < 0.13) at the time of the injection process. Overall, the majority of the participants (56%, N = 22) had a systolic blood pressure of ≥ 180 mmHg. Conclusions Our results show that the blood pressure increase occurs persistently during the injection process in some patients. Repeated episodes of severe hypertension may predispose patients to cardiovascular events, especially those with concomitant cardiovascular risk factors.

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