Monday, August 28, 2023

Antipsychotic Polypharmacy Increases Risk of Hypertension, Study Suggests

Individuals who take multiple antipsychotics to manage schizophrenia symptoms have three times the risk of developing hypertension relative to those taking one antipsychotic, according to a study published in Schizophrenia Bulletin. The risk of hypertension was greatest when the patients were taking multiple first-generation antipsychotics.

“[T]he risks of developing hypertension and its cardiovascular consequences over time need to be considered when making decisions on whether [antipsychotic polypharmacy] is justified,” wrote Emily Eyles, Ph.D., of the University of Bristol and colleagues. If antipsychotic polypharmacy is determined to be necessary, patients should receive regular blood pressure monitoring and potentially antihypertensive treatment to reduce cardiovascular risk, Eyles and colleagues continued.

The researchers compiled three study cohorts using data from the U.K. Clinical Practice Research Datalink, which includes de-identified patient records from over 700 primary care centers across the United Kingdom. The researchers identified adults with schizophrenia who received a new prescription for one or more antipsychotics between July 1, 1994, and August 30, 2018, and who had no history of diabetes (cohort 1), hypertension (cohort 2), or hyperlipidemia (cohort 3). Patients in each cohort were tracked for up to five years; until they received a diagnosis for diabetes, hypertension, or hyperlipidemia; they stopped taking antipsychotics; or they were no longer being seen by the practice.

In total, 1,663, 1,268, and 1,668 adults with schizophrenia were assessed for incidence of diabetes, hypertension, and hyperlipidemia, respectively. The average follow-up period was 14 months; during this time, 4.4% of the first cohort developed diabetes, 6.6% of the second cohort developed hypertension, and 3.8% of the third cohort developed hyperlipidemia.

Compared with adults taking one antipsychotic, those taking multiple antipsychotics had 3.16 times the risk of developing hypertension, even after adjusting for multiple variables including smoking, body mass index, psychiatric comorbidities, and total antipsychotic dose. There was no evidence of an association between antipsychotic polypharmacy and diabetes or hyperlipidemia.

To read more on this topic, see the Psychiatric News article “Study Finds Higher-Dose Antipsychotic Polypharmacy Does Not Increase Hospitalization.”

(Image: iStock/Bill Oxford)

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