Blood Pressure and Heart Rate Changes During Clozapine Treatment.
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.
University of Maryland School of Pharmacy, 20 N. Pine St, Baltimore, MD, 21201, USA.
Sarah M
SM
Norman
Marsico Lung Institute/Cystic Fibrosis Center, University of North Carolina at Chapel Hill, 7222 Marsico Hall CB #7248, Chapel Hill, NC, 27599, USA.
Kelli M
KM
Sullivan
Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD, 21228, USA.
Fang
F
Liu
University of Maryland School of Pharmacy, 20 N. Pine St, Baltimore, MD, 21201, USA.
Bethany A
BA
DiPaula
Division of Renal Diseases & Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I St NW #601, Washington, DC, 20052, USA.
Pedro A
PA
Jose
Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD, 21228, USA.
Christopher A
CA
Kitchen
Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD, 21228, USA.
Stephanie M
SM
Feldman
Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD, 21228, USA. dkelly@mprc.umaryland.edu.
Deanna L
DL
Kelly
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D003024:Clozapine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D013610:Tachycardia / Q000139:chemically induced; D055815:Young Adult
D014150:Antipsychotic Agents; D003024:Clozapine
Blood pressure; Clozapine; Heart rate; Hypertension; Schizophrenia; Tachycardia
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