What’s New in Schizophrenia and Cardiovascular Disease?

Question 1. Hypertension in patients with schizophrenia has been associated with all of the following EXCEPT:

A. Greater cognitive impairment
B. Greater positive psychopathology
C. Lower quality of life
D. Premature mortality

The correct answer is B.

• One study found a significant negative effect of hypertension on memory (immediate, delayed, and recognition) in patients with schizophrenia.

• Another study found that higher pulse pressure (the difference between systolic and diastolic blood pressure), but not glucose or abdominal obesity, predicted generalized neurocognitive deficits in patients with schizophrenia.

• Hypertension, but not elevated BMI, may also negatively impact quality of life in schizophrenia

• A retrospective community-based cohort of patients with schizophrenia found that those with hypertension were significantly more likely to die over a 9-year follow-up period.

Lev-Ran S, Le Strat Y, Le Foll B. Impact of hypertension and body mass index on quality of life in schizophreniav. Am J Psychiatry. 2011;168:552-553.

Morra LF, Strauss GP. Severity of hypertension predicts the generalized neurocognitive deficit in schizophrenia. Schizophr Res. 2016;176:527-528.

Friedman JI, Wallenstein S, Moshier E, et al. The effects of hypertension and body mass index on cognition in schizophrenia. Am J Psychiatry. 2010;167:1232-1239.

Gur S, Weizman S, Stubbs B, et al. Mortality, morbidity and medical resources utilization of patients with schizophrenia: A case-control community-based study. Psychiatry Res. 2018;260:177-181.

Question 2. In the CATIE schizophrenia trial, the rate of non-treatment of hypertension was approximately:

A. 30%
B. 40%
C. 50%
D. 60%
E. 70%

The correct answer is D.

• Using baseline data from the CATIE trial (n=1460), one-third of patients with schizophrenia had hypertension.

• Rates of non-treatment ranged from 30.2% for diabetes, to 62.4% for hypertension, and 88.0% for dyslipidemia.

• Hispanic patients were significantly less likely than non-Hispanics to be treated for hypertension.

Nasrallah HA, Meyer JM, Goff DC, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res. 2006;86:15-22.

Question 3. Hypertension may be more common in which unaffected first-degree relatives of patients with schizophrenia compared to controls?

A. Mothers
B. Fathers
C. Sisters
D. Brothers

The correct answer is C.

• In the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects, only female siblings of patients with schizophrenia had an increased risk of hypertension (OR=1.47, 95% CI 1.07-2.01).

Huang MH, Chen MH, Huang KL, et al. Increased risk of type 2 diabetes among the siblings of patients with schizophrenia. CNS Spectr. 2019;3:1-7.

Question 4. Acute treatment (within the first 3 days) with which of the following antipsychotics has been associated with a significant increase in systolic blood pressure:

A. Aripiprazole
B. Clozapine
C. Olanzapine
D. Quetiapine
E. Ziprasidone

The correct answer is C.

• In a retrospective chart review of 60 patients, olanzapine and risperidone were associated with a significant increase in systolic blood pressure.

• Clozapine significantly reduced systolic blood pressure and was associated with hypotension.

• There were no significant changes in blood pressure with aripiprazole, quetiapine, or ziprasidone.

Parks KA, Parks CG, Yost JP, et al. Acute Blood Pressure Changes Associated With Antipsychotic Administration to Psychiatric Inpatients. Prim Care Companion CNS Disord. 2018;20(4).

Question 5. Clinical trials have shown that adjunctive treatment with anti-hypertensive agents have been associated with improvements in psychopathology and/or cognition in patients with schizophrenia for all of the following classes EXCEPT?

A. Angiotensin-receptor blockers
B. Calcium-channel blockers
C. Sodium nitroprusside
D. Thiazide diuretics

The correct answer is D.

 • Adjunctive telmisartan (angiotension-receptor blockers) was associated with a significant decrease in PANSS total score (but not PANSS subscales), but no change in cognition.

• Adjunctive nilvadipine (calcium-channel blocker) was associated with a significant decrease in BPRS total score, particularly for emotional withdrawal and uncooperativeness items.

• IV sodium nitroprusside was associated with a rapid (within 4 hours) improvement of psychopathology (BPRS), which persisted for 4 weeks after infusion.

Fan X, Song X, Zhao M, et al. The effect of adjunctive telmisartan treatment on psychopathology and cognition in patients with schizophrenia. Acta Psychiatr Scand. 2017;136:465-472.

Yamada K, Kanba S, Ashikari I, et al. Nilvadipine is effective for chronic schizophrenia in a double-blind placebo-controlled study. J Clin Psychopharmacol. 1996;16:437-439.

Hallak JE, Maia-de-Oliveira JP, Abrao J, et al. Belmonte-de-Abreu P, Baker GB, Dursun SM. Rapid improvement of acute schizophrenia symptoms after intravenous sodium nitroprusside: a randomized, double-blind, placebo-controlled trial. JAMA Psychiatry. 2013;70:668-676.

Editor's note: This article was originally published on February 14, 2019 and has since been updated.