Psychiatric Medications and Hypertension
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HYPERTENSION AND EMERGENCY MEDICINE (T RAINER AND P LEVY, SECTION EDITORS)
Psychiatric Medications and Hypertension M. K. Morreale 1 & L. A. Wake 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to provide an overview of psychiatric medications that impact blood pressure in adult patients either as a direct side effect or indirectly, via negative metabolic impact or interactions with other medications. In addition, pertinent interactions between psychiatric medications and antihypertensive agents will be discussed. Recent Findings Although the novel intranasal antidepressant, esketamine, has been shown to increase blood pressure shortly after dosing, treatment with antihypertensive medications is not typically required. In addition, no increase in serious adverse cardiac events was reported with this medication. The negative metabolic impact of antipsychotic medications has been shown to occur within the first month of treatment and necessitates early monitoring. When compared with the general population with cardiovascular disease, mortality risk in patients with severe and persistent psychiatric illness is higher, and death occurs 10 years earlier. Summary There are several psychiatric treatments that increase blood pressure directly as well as indirectly, via negative metabolic impact and drug/diet interactions. Fortunately, there are no absolute contraindications for use of any psychiatric medication in patients with pre-existing hypertension. Given data which suggests that patients diagnosed with more severe psychiatric disorders are known to receive inadequate medical care for hypertensive illness and experience increased mortality risk from cardiovascular disease, it is important for all physicians to be aware of the increased risk in this population and for both thorough assessment and treatment to occur. Keywords Psychiatric illness . Psychiatric treatment . Psychopharmacology . Hypertension
Introduction Both hypertension and psychiatric disorders are common in the USA, with approximately one-half of adults diagnosed with the former condition and one-fifth, the latter [1–2]. The economic impact of these illnesses is significant, with an estimated $48.6 billion (2015) spent on direct medical costs related to hypertension and $37.7 billion (2013) for schizophrenia alone [3–4]. As a substantial proportion of individuals with chronic physical illness, including hypertension, also have a mental health disorder, physicians are likely to assess and treat patients who have been diagnosed with both [5]. This article is part of the Topical Collection on Hypertension and Emergency Medicine * M. K. Morreale [email protected] 1
Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
Although the literature is controversial, there are studies that indicate a direct association between several psychiatric disorders and risk of hypertension. For example, patients with depress
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