Assessing the Occurrence of Hypertension in Patients Receiving Calcitonin Gene-Related Peptide Monoclonal Antibodies for Episodic and Chronic Migraine: A Systematic Review

Calcitonin gene-related peptide (CGRP) monoclonal antibodies have emerged as effective preventive treatments for episodic and chronic migraine, but concerns have been raised regarding their potential cardiovascular safety profile, particularly the risk of hypertension. This systematic review aimed to assess the occurrence of hypertension in patients receiving CGRP monoclonal antibodies for migraine prevention. A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library was conducted for studies published between January 2015 and June 2025. Five studies met the inclusion criteria, encompassing 75,065 patients across randomized controlled trials, observational studies, and real-world cohort analyses. The evidence suggests a differential risk profile between CGRP receptor antagonists and ligand-targeting antibodies, with erenumab (receptor antagonist) demonstrating greater blood pressure increases compared to fremanezumab. In patients with baseline hypertension, anti-CGRP treatment was associated with a slight annual increase in antihypertensive medication requirements, while normotensive patients showed minimal blood pressure changes. Clinical trials reported low incidence rates of hypertension adverse events, though post-marketing surveillance identified 362 hypertension events in over 245,000 patient-years of exposure. The temporal pattern suggests cumulative rather than immediate effects, with a small proportion of normotensive patients requiring antihypertensive treatment after erenumab initiation. These findings indicate that while the overall risk of hypertension appears modest, clinically meaningful effects on blood pressure regulation may occur, particularly in patients with pre-existing hypertension. Regular cardiovascular monitoring is recommended for patients receiving CGRP monoclonal antibodies, especially those with baseline cardiovascular risk factors.