PHA and PSH support the National Immunization Program for COVID19.
Transient blood pressure elevations were reported during vaccination, but to date, none are directly attributed to any of the COVID19 vaccines. Blood pressure elevation may be due to pain on injection site, anxiety, environmental factors, or a reflection of pre-existing undiagnosed or uncontrolled hypertension.
Along with vaccination for COVID19, it is equally important that screening for, and optimal control of hypertension are continuously done in the community to reduce the risk of severe COVID19 complications. Hypertension is NOT a disqualifier to COVID19 vaccination and to date, none of the COVID19 vaccines with EUA approval for patients with comorbidities specifically state that elevated blood pressure is a contraindication. The risks of vaccination are outweighed by the large benefit that includes the significant reduction of severe COVID infection and mortality.
Specifically, we recommend the following:
1. Accurate blood pressure measurement must be done before and after vaccination (a)
2. Elevations of the sBP > 180 and /or dBP >120 with signs and symptoms of target organ damage (b)
(TOD) or hypertensive-mediated organ damage (HMOD) such as Acute Coronary Syndrome, Heart Failure, Stroke and Acute Kidney Injury, is considered as Hypertensive Emergency and should be referred to the ER immediately (level I, 2017 ACC AHA). In this case vaccination is ideally rescheduled until this life-threatening condition has been stabilized.
3. Individuals with BP elevations not classified as Hypertensive Emergency, may be vaccinated, but must be observed for 30 to 60 minutes post vaccination, monitoring for evolving signs or symptoms of hypertensive emergency, as well as hypotension which may be a manifestation of anaphylaxis.
4. Sublingual medications to lower the blood pressure are no longer recommended due to its adverse effects. Conservative measures including relaxation techniques such as deep breathing exercises, placing the patient in a comfortable environment, allowing patient to void, may help.
5. All individuals with persistent BP elevation not classified as Hypertensive Emergency must be counseled to seek clinic consult for proper work up the soonest possible time.
PHA and PSH will continue to monitor the rapidly evolving landscape of COVID19 vaccination and are committed to update these interim statements as needed or as new data become available.
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a. Accurate BP measurement must be done in a quiet room with comfortable temperature, and must be done at least 30 minutes after exercise, drinking coffee, or smoking, and ideally after voiding urine. The cuff bladder must cover 75 to 100% of the individual’s arm circumference. The patient must be seated, with the back supported, and feet flat on the floor. BP must be taken with the arm bare and resting, with the mid arm at heart level, and the cuff bladder must cover 75 to 100% of the arm circumference.
b. Symptoms of TOD or HMOD include headache and dizziness attributed to a possible neurologic deficit, visual disturbance, chest pain, and difficulty of breathing). Elevations of the sBP > 180 and /or dBP >120 without TOD/HMOD is considered as Hypertensive Urgency. Patients in such cases are advised to reinstitute or intensify oral treatment and arrange for close follow up (2017 ACC AHA).
Released on March 19, 2021
