Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Woo, Young Sup; Kim, Won; Chae, Jeong‐Ho; Yoon, Bo-Hyun; Bahk, Won‐Myong

doi:10.1080/15622970801910399

Cited by 31 publications

(22 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies performed in different countries and in different age groups of patients treated with RSP[11] or OZP[1213] have not clinically revealed significant changes in cardiovascular parameters and blood pressure, which is similar to our study.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Comparative cardiovascular safety of risperidone and olanzapine, based on electrocardiographic parameters and blood pressure: A prospective open label observational study

2014

View full text Add to dashboard Cite

Objective:To assess the cardiovascular safety of two commonly prescribed atypical antipsychotics risperidone (RSP) and olanzapine (OZP) in schizophrenic patients, using electrocardiography (ECG) and Blood Pressure (BP).Materials and Methods:This was a 10-week prospective open label, observational study, carried out in a newly diagnosed 64 schizophrenic patients receiving either RSP or OZP. RSP (n = 32) was started with dose of 2 mg/day and increased to 4 mg/day after 2 weeks, whereas OZP (n = 32) was started at a dose of 5 mg/day and was increased to 10 mg/day after 2 weeks. Heart rate (HR), ECG parameters (PR, RR, QRS, QT intervals and QTc and QTd) and BP (systolic and diastolic in supine and standing position) were recorded at baseline (before drug therapy)) and during follow-up visits at 2(I), 6(II) and 10(III) weeks.Results:In the RSP group, at II and III follow-ups, a significant increase in the HR (P = 0.018, P = 0.011 respectively) as well as in QTc (P = 0.025, P = 0.015, respectively) was observed when compared to the basal values. In the OZP group, diastolic BP was significantly decreased in standing position at II and III follow-ups (P = 0.045 and P = 0.024, respectively) compared to the basal values. When the two groups were compared with each other, no significant differences were observed in the changes of HR, PR, QRS, QT, RR, QT, QTd and SBP (supine and standing position); and DBP (supine position). However, DBP in standing position showed a significant decrease in the OZP group at II and III follow-up (P = 0.036 and P = 0.016, respectively) compared to the RSP group.Conclusions:Patients treated with OZP are at higher risk to develop postural hypotension as compared with RSP; hence RSP could be better tolerated by patients taking antihypertensive drugs as compared with OZP whereas OZP would have a safer cardiac profile.

show abstract

Section: Discussionsupporting

confidence: 91%

“…The cardiovascular safety of RSP[11] and OZP[1213] has been studied in different countries and different age group but their status regarding Indian population is not known.…”

Section: Introductionmentioning

confidence: 99%

Comparative cardiovascular safety of risperidone and olanzapine, based on electrocardiographic parameters and blood pressure: A prospective open label observational study

2014

View full text Add to dashboard Cite

show abstract

“…Additionally, a significant positive correlation between weight gain and the increase in SBP was described [28]. Woo et al compared CLZ with olanzapine and up to 16.7 % of CLZ patients met criteria for hypertension over that time period, compared with 5.4 % on olanzapine [29]. In a small study by Oyewumi et al, autonomic dysfunction during CLZ dose titration was demonstrated [30].…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure and Heart Rate Changes During Clozapine Treatment

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

“…Large-population studies and twin studies have linked SGK1 haplotypes to high systolic and diastolic blood pressures (Busjahn et al, 2002;von Wowern et al, 2005). Therefore, it is interesting to note that Woo et al (2009) reported that clozapine, but not olanzapine, produced a significant increase in blood pressure in schizophrenic patients. Hypertension is also a recognized side effect of lithium treatment (Vestergaard et al, 1980).…”

Section: Discussionmentioning

confidence: 99%

Clozapine and lithium require Caenorhabditis elegans β‐arrestin and serum‐ and glucocorticoid‐inducible kinase to affect Daf‐16 (Foxo) localization

Weeks

Dwyer

Aamodt

2011

J of Neuroscience Research

View full text Add to dashboard Cite

Numerous studies have implicated low levels of signaling in the Akt network with psychotic illnesses, and a growing body of literature has shown that all classes of antipsychotic drugs increase Akt signaling. The most clinically effective antipsychotic drug is clozapine. With Caenorhabditis elegans as a model system, this study demonstrates that clozapine is unique among antipsychotic drugs because it requires β-arrestin and serum and glucocorticoid-inducible kinase (SGK) in addition to Akt to suppress the nuclear localization of DAF-16 (Forkhead box O [FOXO]). Lithium, a mood stabilizer often used to treat psychosis, also requires β-arrestin and SGK to suppress the nuclear localization of DAF-16.

show abstract

Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients

Abstract: Our findings suggest that clozapine treatment may be associated with increased blood pressure and higher prevalence of hypertension, which may have a significant impact on medical morbidity and mortality.

Cited by 31 publications

References 26 publications

Comparative cardiovascular safety of risperidone and olanzapine, based on electrocardiographic parameters and blood pressure: A prospective open label observational study

Comparative cardiovascular safety of risperidone and olanzapine, based on electrocardiographic parameters and blood pressure: A prospective open label observational study

Blood Pressure and Heart Rate Changes During Clozapine Treatment

Clozapine and lithium require Caenorhabditis elegans β‐arrestin and serum‐ and glucocorticoid‐inducible kinase to affect Daf‐16 (Foxo) localization

Contact Info

Product

Resources

About