At the Kanoya Heart Center, we have been measuring blood pressure before vaccination with the COVID-19 vaccine. The person in the figure below is in his 60s, but he had never had a checkup and was not taking any medication. His blood pressure before inoculation was 254 mmHg. I was surprised. It is no wonder that such a person could die of intracerebral hemorrhage at any time. We decided not to vaccinate him, but to wait until his high blood pressure was under control. His blood pressure is now normal, and he was able to complete the vaccination successfully.
Is such a person an exception? The figure above is from the guidelines published by the Japan Society of Hypertension. It is an estimate, but there are 18.5 million people with untreated hypertension in Japan. If the population of people over 12 years old who are eligible for vaccination is 110 million, 17% of them have hypertension. That's about 1 in 6 people. The number of people with extreme cases like the one in the figure below is probably much smaller, but I think it is important to remember that a not small number of people at risk of sudden death are coming for vaccinations.
As of November 2021, about 1,300 people have died after vaccination in Japan. Of these, 389 were deaths of cardiac origin closely related to hypertension, 180 were deaths of the cerebral nervous system such as cerebral hemorrhage and infarction, and 61 were aortic dissection. In total, 620 people died. Approximately half of the deaths were related to hypertension.
Considering this, I thought it would be safer to measure blood pressure before vaccination and suspend vaccination in high-risk patients, and to treat hypertension first and then vaccinate. I thought it would be safer to treat the hypertension first and then vaccinate after it had stabilized. Of the approximately 1,200 people who first came to our clinic for vaccination, about 100 had high blood pressure at the time of the first vaccination, and we asked them to measure their blood pressure at home until the second vaccination three weeks later. As a result, half of the patients, about 50, also had high blood pressure at home, so we started their treatment.
Before the corona vaccination started, there was a discussion in the Kanoya Medical Association. There was a debate in the Kanoya Medical Association before the COVID-19 vaccination started, between medical institutions that would measure blood pressure and those that would not. One of the doctors at the medical institution that said they would not do it said that he asked an infectious disease specialist and was told that it was unnecessary, so he would not do it. I am sure that the infectious disease specialists do not know that there are so many people with untreated hypertension. Therefore, I believe that cardiologists are the ones who should be consulted to ensure the safe implementation of vaccination.
The third round of vaccinations will begin soon. For safer vaccination, I recommend that blood pressure be measured at each medical institution where vaccinations are given. If possible, mass vaccination is also recommended, but it may be difficult. If this is the case, we recommend that the person receiving the vaccination bring a record of their home blood pressure to the vaccination site for their own protection.
