Does Repatha Cause Elevated Blood Pressure?
No, Repatha (evolocumab) does not cause elevated blood pressure. In fact, uncontrolled hypertension was an exclusion criterion in the major clinical trials, indicating blood pressure was monitored as a safety concern, but elevated BP was not identified as an adverse effect of the medication itself.
Evidence from Major Clinical Trials
The landmark FOURIER trial, which enrolled 27,564 patients with established cardiovascular disease, specifically excluded patients with uncontrolled blood pressure from participation 1. This exclusion criterion was implemented as a baseline safety measure, not because evolocumab causes hypertension.
Safety Profile of Evolocumab
The documented adverse effects of evolocumab are limited and well-characterized:
- Injection site reactions were the most common adverse effect, occurring in 2.1% of evolocumab patients versus 1.6% of placebo patients 1, 2
- These reactions were predominantly mild, with only 0.1% of patients in each group discontinuing treatment due to injection site issues 1
- No major safety concerns were identified across multiple large-scale trials 3
Common Adverse Effects (Not Including Hypertension)
The established side effect profile includes 4, 5:
- Nasopharyngitis
- Injection site reactions
- Influenza
- Upper respiratory tract infections
Notably absent from this list is any mention of elevated blood pressure or hypertension.
Long-Term Safety Data
The OSLER-1 trial evaluated evolocumab for up to 5 years in over 1,000 patients, demonstrating excellent tolerability with an annual discontinuation rate of only 1.4% 1. Throughout this extended follow-up period, elevated blood pressure was not reported as an adverse event.
Clinical Implications
If you are observing elevated blood pressure in a patient taking Repatha, consider alternative explanations:
- Progression of underlying cardiovascular disease (the indication for which Repatha was prescribed)
- Concurrent medications that may affect blood pressure
- Natural disease progression in high-risk cardiovascular patients
- Lifestyle factors or other comorbidities
The extensive clinical trial data spanning multiple years and tens of thousands of patients provides strong reassurance that evolocumab does not cause hypertension 1, 2, 3.