Risk of underdiagnosis of hypertension in schizophrenia patients

Aim: Arterial hypertension requires proper screening and management, and its underdiagnosis in patients with schizophrenia (SZ) and/or antipsychotic treatment has been postulated. The objective of the study is to assess whether there are differences in the proportion of screened patients with a blood pressure >140/90 mmHg that are undiagnosed or not confirmed later (risk of underdiagnosis). Methods: Cross-sectional study of clinical records from SIDIAPQ (Spain) during the 2006–2011 period. Three groups were studied: SZ, no SZ but under antipsychotic treatment, and control groups. Patients with established hypertension, cardiovascular disease, dementia, or diagnosis of SZ or starting with antipsychotic treatment during this period were excluded. Results: The SZ group had a lower risk of underdiagnosis than the control group (OR 0.91; 95% CI: 0.83–0.99; p < 0.05), at the expense of men (OR 0.8; 95% CI: 0.71–0.9; p < 0.001) and patients younger than 50 years of age (OR: 0.84; 95% CI: 0.74–0.93; p < 0.003). In the no SZ but under antipsychotic treatment group there were some differences, but not in the overall results. Conclusion: Preventive management of hypertension seemed to be sufficient for SZ and antipsychotic treatment patients. The lower prevalence of hypertension found in these groups may be due to other factors (blood pressure-lowering effect of psychoactive drugs or smoking) but these hypotheses must be evaluated with specific studies

Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

<p>Many studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population.</p> <p>Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking.</p> <p>A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence.</p> <p>The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required.</p> <p><b>Abbreviations</b>: Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose (DDD).</p