Blood pressure can be seriously elevated during botulinum toxin A detrusor injection

World Journal of Urology, 2025 · DOI: https://doi.org/10.1007/s00345-025-05596-3 · Published: March 21, 2025

Simple Explanation

This study investigates the effect of Botulinum toxin A detrusor injections (BoNT/A-DI) on blood pressure in patients with overactive bladder (OAB) or neurogenic bladder. The injections are typically given under local anesthesia. Researchers monitored blood pressure and heart rate during the procedure, focusing on patients with and without hypertension, as well as those receiving initial versus repeat injections. The aim was to identify potential cardiovascular risks. The study found that blood pressure, especially systolic blood pressure, significantly increased during BoNT/A-DI, particularly in patients with a history of hypertension. This elevation could pose a risk for cardiovascular events.

Study Duration

Not specified

Participants

70 female patients with OAB or neurogenic bladder

Evidence Level

Not specified

Key Findings

1
Systolic blood pressure increased significantly by an average of 9.8 mmHg across all patients during the procedure.
2
In hypertensive patients, systolic blood pressure rose by an average of 19.4 mmHg, with some experiencing peak systolic values up to 232 mmHg and diastolic values up to 128 mmHg.
3
Cardiac stress, measured by the rate pressure product (RPP), significantly increased in hypertensive patients compared to non-hypertensive patients (RPP = 17.6 vs. 7.2).

Research Summary

The study examined the impact of botulinum toxin A detrusor injections (BoNT/A-DI) on blood pressure in patients with overactive bladder (OAB) or neurogenic bladder, focusing on cardiovascular risk factors. The results indicated that systolic blood pressure significantly increased during BoNT/A-DI, especially in patients with a history of hypertension, leading to elevated cardiac stress. The authors conclude that clinicians should monitor blood pressure during BoNT/A-DI, particularly in hypertensive patients, and consider internal medicine consultation for those with significantly elevated pre-interventional blood pressure to mitigate cardiovascular risks.

Practical Implications

Blood Pressure Monitoring

Clinicians should routinely monitor blood pressure before, during, and after BoNT/A-DI, especially in patients with known hypertension or elevated resting blood pressure.

Cardiovascular Risk Assessment

Patients with significantly elevated pre-interventional blood pressure should receive an internal medicine consultation to assess and manage cardiovascular risks before undergoing BoNT/A-DI.

Medication Management

Patients should be advised to take their antihypertensive medications on the day of the injection procedure to help manage blood pressure levels.

Study Limitations

1
The study focused solely on female patients.
2
The study did not explore the long-term cardiovascular outcomes associated with blood pressure elevations during BoNT/A-DI.
3
The influence of bladder filling on blood pressure might be partially ameliorated by reduced bladder filling

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