Use of atypical antipsychotics and risk of hypertension: A case report and review literature

Abstract

Atypical antipsychotics is being considered in the treatment of “negative” symptoms of psychoses, such as schizophrenia. In this case report, we presented a case of a patient with psychiatric disorder who developed hypertension soon after starting using atypical antipsychotic. A 53-year-old woman had reported having episodes of tachycardia, nausea, headache and high blood pressure. At the time of the doctor’s appointment, the blood pressure was 210/110 mmHg. According to the patient, she made use of simvastatin for dyslipidemia and started taking aripiprazole, an antipsychotic for approximately 40 days before the symptoms. The initial treatment was 20 mg of olmesartan, and examinations were requested. After 2 months, the patient returned with the examinations: altered serum lipids and the other results were normal. Ambulatory blood pressure monitoring showed an average of 24 h of 150/100 mmHg. Blood pressure was measured at the doctor’s office; in regular use of 20 mg of olmesartan, it was 156/92 mmHg. The dosage of olmesartan was increased to 40 mg and 1.5 mg of indapamide was initiated. The patient returned after 20 days with a blood pressure of 146/90 mmHg. After approval from the psychiatrist, the Aripiprazole was stopped, and the patient returned 15 days later with blood pressure of 120/80 mmHg. The ambulatory blood pressure monitoring control showed an average of 24 h of 130/78 mmHg. The Dopamine receptors play a role in the regulation of the blood pressure and the alterations in this system can lead to hypertension. D1, D3 and D4 receptors interact with the renin-angiotensin-aldosterone system, while D2 and D5 interact with the sympathetic nervous system in the regulation of PA. The case reported and the literature review bring to light the discussion of the use of atypical antipsychotics and its adverse events. If necessary, the use of these drugs should be followed by careful monitoring of blood pressure.

Levels of Interleukin 6 as a Predictor of Metabolic Syndrome in Schizophrenic Patients Receiving Combination Therapy of Typical and Atypical Antipsychotics

“…Receptors D1, D3, and D4 interact with the renin-angiotensin-aldosterone system, whereas D2 and D5 with post-ganglia presynaptic sympathetic nerves. When activated, the receptors inhibit norepinephrine production at sympathetic nerve endings, leading to increased blood pressure [25]. In this study, there was also an increase in blood pressure's mean value in the 3 rd month after giving antipsychotic drug therapy.…”

Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness

“…The literature on the appearance of hypertension due to antipsychotics seems to be restricted to case studies/series ( 78 , 79 ). The largest existing cohort study, comprising 284,234 individuals, showed that those with 1 year of exposure to SGAs showed only a small heightened risk of essential hypertension (Hazard Ratio, HR = 1.16, p < 0.0001), compared to those using antidepressants ( 80 ) ( Table 1 ).…”

“…Moreover, there does not seem to be an additive effect on blood pressure when combining antipsychotics ( 51 ). The possible small increased risk in hypertension after antipsychotic treatment probably can be attributed to antipsychotic-induced weight gain/obesity ( 81 ) and to the anti-dopaminergic effect of these agents, as all 5 dopamine receptor subtypes (D1–D5) regulate blood pressure ( 78 , 82 ).…”

Adverse Events of Risperidone and Clozapine Combination Therapy on Schizophrenic Patients at Magelang Mental Hospital

“…36 Efek peningkatan tekanan darah setelah pasien diberikan terapi kombinasi risperidon dan klozapin tidak terjadi dapat disebabkan oleh durasi terapi yang terlalu singkat, profil farmakokinetik, dan adanya efek sinergisme farmakologi. 37,38 Mekanisme peningkatan berat badan sangat berpengaruh pada patogenesis sindroma metabolik, secara tidak langsung hambatan pada reseptor neurobiologi di otak mampu meningkatkan rasa lapar. 39 Kombinasi risperidon dan klozapin memiliki efek mutatif terhadap reseptor serotonin (5HT2C) dan LEP-2548 A/G yang menyebabkan peningkatan berat badan dalam waktu 6-16 minggu.…”