Weight and blood pressure changes after switching second-generation antipsychotics in a population of veterans with schizophrenia-related disorders

Abstract

ObjectivesTo describe (1) the association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes and weight change and (2) weight, SBP, and DBP changes attributable to the medication following a switch from one second- generation antipsychotic (SGA) to another. DesignRetrospective, naturalistic, nonequivalent control group study. SettingUnited States between April 1, 2002, and September 30, 2002. Patients1,425 U.S. Veterans Healthcare System enrollees with diagnoses of schizophrenia or schizoaffective disorders. InterventionAnalysis of data from the Veterans Integrated System Technology Architecture. Main outcome measuresVeterans’ weight, SBP, and DBP. ResultsWeight change and change in SBP (r=0.19) and DBP (r=0.15) were significant (P<0.001), even after adjusting for obesity status (body mass index <30 or ≥30kg/m2). Veterans who were switched from olanzapine to another SGA lost weight (P<0.001), whereas those switched from another SGA to olanzapine gained weight (P<0.05). Weight change remained significant after controlling for preswitch obesity status (P<0.001 ). Blood pressure was not associated with switch type after adjusting for preswitch obesity status. ConclusionMonitoring and aggressively treating weight change is an evidence- based and relatively inexpensive strategy that primary care practitioners and psychiatrists can use in working in tandem toward reducing the already greater cardiovascular risk of patients with schizophrenia.