A Double-Blind, Randomized, Crossover Assessment of Blood Pressure Following Administration of Avitriptan, Sumatriptan, Or Placebo To Patients with Mild To Moderate Hypertension

Abstract

We examined the effects of avitriptan, a 5-hydroxytryptamine 1-like (5HT1) receptor agonist for the treatment of migraine, in patients with medicated, controlled, mild to moderate hypertension relative to placebo and sumatriptan. The study was randomized, double-blinded, placebo-controlled, and 4-way crossover in design. Twenty patients (12M, 8F) participated. As required by protocol, all were stable on medications for mild to moderate hypertension, with a supine diastolic blood pressure of < 95 mmHg. Qualified subjects were randomized to receive oral administration of either 75 or 150 mg of avitriptan, 100 mg sumatriptan or placebo during the four treatment visits. Supine blood pressure and pulse rates were recorded up to 24 h after drug administration. Avitriptan 150 mg significantly increased peak diastolic and systolic blood pressure, and mean arterial pressure compared to placebo and sumatriptan 100 mg (p < 0.05). Only those hypertensive patients receiving medication for hypertension should receive anti-migraine medications, such as avitriptan, which are 5HT1-like receptor agonists.

Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial

“…In our trial, elevated blood pressure was the most commonly reported adverse event in all three groups, but it occurred most frequently in the sumatriptan group. Previously published trials reported similar findings for sumatriptan in healthy subjects or migraineurs without hypertension [22] and in hypertensive patients who were being treated with antihypertensive medications [23]. Four patients in the sumatriptan group experienced chest‐related symptoms.…”

Cardiovascular effect of almotriptan in treated hypertensive patients

“…22 For this reason, studies of the effects of triptans on blood pressure, whether with healthy volunteers or those with controlled hypertension, were performed on otherwise healthy volunteers with no history of migraine. 11,16 In general, the treatments administered in this study were well tolerated. Almotriptan had no effect on pulse or electrocardiographic parameters; these results are consistent with previous reports.…”

“…This is illus- trated by the profound effects observed for avitriptan after administration in 1 of 4 subjects with uncontrolled hypertension in a clinical trial. 11 The concern for the triptans during development is whether these agents produce profound blood pressure effects in patients with hypertension controlled by medication. The pharmacokinetic characteristics of migraineurs for the triptan agents were not different from those of healthy volunteers; the only effects observed were a delayed time to peak plasma concentrations during the migraine, and these were generally modest.…”

“…Mild and transient increases in blood pressure have been associated with 5-HT 1B/1D agonists in healthy volunteers and in patients with controlled hypertension. Mild and transient increases in blood pressure have been reported with sumatriptan, 10 avitriptan, 11 rizatriptan, 12 and naratriptan. 13 Zolmitriptan showed either no increase 14,15 or only a small clinically insignificant increase in both subjects with hypertension and in control subjects.…”