Hypertension after mRNA COVID-19 vaccine
Question:
6/2/2021
A 42-year-old woman received first dose of Moderna vaccine. After 30 minutes while walking to her car, she became flushed and tachycardia. This continued and BP was elevated up to 180/130. I saw her in my office three days later and patient flushed from neck up and same BP. She was admitted to the hospital and extensive workup including blood, urine and scans for pheocromocytoma, carcinoid, mastocytosis performed. All results normal. She had had periodic flushing in the past and one visit prior to this to an UrgiCare facility revealed elevated diastolic BP of 95. Hypertension has not been a problem in general. RAST testing positive to cat, dog, trees, grass, mold. At present patient is requiring nifedipine 60mgs daily to control BP. There is a report of 11 patients in Switzerland getting hypertension after mRNA COVID-19 vaccine. Any suggestions for further workup or diagnosis.
Answer:
There is no immunologic explanation for vaccinations in general or mRNA vaccines in particular to cause persistent elevation of blood pressure. The reports from Switzerland described in an increase in both diastolic and systolic blood pressure in patients receiving the Pfizer vaccine (one received Moderna) [1]. The prevalence of this was approximately 0.07% although the authors noted that blood pressure is not routinely checked before and after. A supermajority of these cases had a history of pre-existing hypertension and majority were taking antihypertensives at the time of the vaccination. Therefore, an increase in blood pressure may be more common. The Swiss group of patients gradually improved and were not associated with flushing. No mechanism was offered but the phenomenon was felt to be due to anxiety or stress response. I searched the VAERS (CDC Vaccine Adverse Event Reporting System) and did not find reports of hypertension associated with mRNA vaccines (The Vaccine Adverse Event Reporting System (VAERS) Results (cdc.gov)).
In summary, I do not think the vaccination was causally related to the increase in blood pressure but was associated with the increase. The blood pressure change was not related to an immune response. I suspect the increase in blood pressure was due to a stress response.
1. Meylan S, Livio F, Foerster M et al. Stage III hypertension in patients after mRNA-based SARS-CoV-2 vaccination. Hypertension 2021;77:e56-57.
I hope this information is of help to you and your practice.
All my best.
Dennis K. Ledford, MD, FAAAAI