Blood Pressure and Heart Rate Changes During Clozapine Treatment

Abstract

People with schizophrenia are 3–4 times more likely to die from cardiovascular disease than the general population. Clozapine (CLZ) is the gold standard of treatment for refractory schizophrenia. It has been associated with tachycardia and recent evidence shows individuals prescribed CLZ may develop blood pressure (BP) elevation and hypertension. The purpose of this study was to examine the effects of CLZ on BP and heart rate (HR). This was a retrospective chart review of patients 18–75 years old with a DSM IV diagnosis of Schizophrenia or Schizoaffective disorder. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR measured 12 weeks before and 24 weeks during CLZ treatment. Eighteen patient records were included in this study. The mean stabilized CLZ dose was 441.7 ± 171.8 mg/day. DBP (t = 1.02, df = 79.5, = 2.00, 0.049) and HR (t = 1.32, df = 355 = −4.61, < 0.0001) were significantly higher after CLZ initiation. A trend was noted for increase in SBP (p = 0.071). 22 % of patients met criteria for hypertension before CLZ and 67 % during CLZ treatment (Chi Square = 6.25, df = 1, p = 0.0124). No significant changes in weight or renal function occured during CLZ treatment. No patients had evidence of cardiomyopathy. The data suggest CLZ may be associated with a rise in BP and HR. The results of this study support previous literature that found an increase in SBP/DBP regardless of CLZ dose, occurring early in treatment. Due to high risk of cardiovascular morbidity and mortality, more work is needed to determine risk factors and understand the mechanism of action that may cause this side effect.

Activation of the aryl hydrocarbon receptor by clozapine induces preadipocyte differentiation and contributes to endothelial dysfunction

“…In patients diagnosed with schizophrenia, short-term treatment (3 days) with clozapine induced transient hypotension (Parks et al, 2018), most likely due to direct α1 adrenergic receptor antagonism. During 8 weeks of clozapine treatment, heart rate increased and blood pressure shifted toward hypertension (Norman et al, 2017). Although there is no evidence from clinical studies, one might speculate that hypertension in response to long-term clozapine treatment might be linked to AhR signaling.…”

Learned lessons from patients who take clozapine: A case study

“…An approximate incidence of 4% has been reported for the development of hypertension in patients on clozapine . It is considered that adrenergic hyperactivity of clozapine may cause hypertension given the fact that a nonselective beta blocker (e.g., propranolol) can decrease blood pressure . Therefore, Smith was referred to a cardiologist to get an echocardiogram procedures.…”

“…Therefore, Smith was referred to a cardiologist to get an echocardiogram procedures. A beta blocker can be considered while managing sustained tachycardia …”

Multiple Aspects of Inappropriate Action of Renin–Angiotensin, Vasopressin, and Oxytocin Systems in Neuropsychiatric and Neurodegenerative Diseases

“…In comparison with the general population, patients with schizophrenia are more predisposed to CVDs and have a greater risk of adverse cardiac events, such as stroke and heart failure [260][261][262][263][264]. On the other hand, patients with schizophrenia and myocar-dial infarction who receive secondary preventive cardiovascular treatment have a similar mortality rate as the general population [265].…”