APA: Bipolar Patients May Be at Risk for High Blood Pressure

By Kristina Fiore, Staff Writer, MedPage Today

Published: May 23, 2010

Reviewed by Robert Jasper, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

NEW ORLEANS -- Patients with bipolar disorder have a higher prevalence of hypertension than in the general population, putting them at risk for subsequent heart disease, researchers said here.

In a single-center study, the prevalence of hypertension among patients with bipolar disorder was 45%, compared with 30.5% in the general population, Dale D'Mello, MD, of Michigan State University, and colleagues reported at the American Psychiatric Association meeting here.

"Our study suggests the possibility of a link [between bipolar and hypertension]," D'Mello said during a scientific session here.

Previous research has shown that patients with biopolar disorder have a disproportionate burden of cardiometabolic disorders, including heart disease, metabolic syndrome, and stroke.

Yet the underlying mechanisms of this association aren't well understood.

So the researchers assessed 99 patients with bipolar disorder who were treated at St. Lawrence Hospital in Lansing, Mich., between 2002 and 2006.

About half of the patients were male, they had a mean blood pressure of 137/83 mm Hg, and their mean body mass index (BMI) was 30.

There was a high prevalence of smoking, D'Mello said, and 37% were obese.

The researchers found that 45% of the patients were hypertensive - a proportion much higher than recent data from a Healthy People 2010 analysis, which put the prevalence of hypertension in general population at 30.5%.

D'Mello said the hypertensive patients were older (mean age 44 versus 37) and more obese (mean BMI 33 versus 28).

They also had higher mean scores on a mania scale (40 versus 35, P=0.04), as well as earlier onset of bipolar disorder, with a mean age of 24, compared with 29 in nonhypertensive patients (P=0.05).

"They start having hypertension at an earlier age, and have a longer duration," D'Mello said.

But he also noted, "there were many confounding factors we didn't control for in this study."

For example, certain antipsychotic drugs - which some patients may have taken earlier in their lifetime - can lead to metabolic syndrome. The possible role of these medications should be examined in the future, he said.

If it's found that bipolar disease is indeed a cause of hypertension, then "treating bipolar disease may prevent morbidity and mortality," he added, comparing the link to studies that have pointed to depression as a risk factor for coronary artery disease.

"As psychiatrists," he concluded, "we have the opportunity to manage and perhaps prevent a physical disorder."

Primary source:

American Psychiatric Association

Source reference:

D'Mello D, et al "The prevalence and clinical consequences of concurrent hypertension in patients with bipolar disorder" APA 2010; Abstract NR4-17.
Notes:
This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The study did not control for some factors that may have influenced the results, such as previous medications patients may have taken.

D'Mello reported relationships with Pfizer, AstraZeneca, and Shering.

2010 APA Stress Survey

By Christy Matta, MA

How stressed is America?  How stressed are you?  In recognition of the high levels of stress many Americans experience on a daily basis, The American Psychological Association conducts an annual survey to better understand where our stress is coming from.

Stress is an important issue. It affects both our mental health and our physical health. Many people find themselves managing stress by doing things that ultimately lead to more problems. Over or under eating, drinking and smoking are a  few of the behaviors that can create both physical and psychological problems and increase stress over time.

The following are some of the findings reported in a press release from the 2010 APA Stress in America survey.

Women and Stress

• Women are more likely than men (28 percent vs. 20 percent) to report having a great deal of stress (8, 9 or 10 on a 10-point scale).
• Married women report higher levels of stress than single women, with one-third (33 percent) reporting that they have experienced a great deal of stress in the past month
• Married women are more likely than single women to report they have experienced the following due to stress in the past month: feeling as though they could cry (54 percent vs. 33 percent), feeling irritable or angry (52 percent vs. 38 percent), having headaches (48 percent vs. 33 percent) and experiencing fatigue (47 percent vs. 35 percent).

Strategies for Managing Stress

• Women are far more likely than men to say they read to manage stress (57 percent vs. 34 percent for men) and overall, tend to report more stress management activities that connect them with other people, like spending time with friends or family (54 percent vs. 39 percent) and going to church or religious services (27 percent vs. 18 percent).
• Men are more likely than women to say they play sports (16 percent vs. 4 percent) and listen to music (52 percent vs. 47 percent) as a way of managing stress. They are also more likely than women to say they do nothing to manage their stress (9 percent vs. 4 percent

Eating and Stress

• Women are more likely than men to report that they eat as a way of managing stress (31 percent vs. 21 percent). Similarly, women also report having eaten too much or eaten unhealthy foods because of stress in the past month far more often than men (49 percent of women vs. 30 percent of men).
• Significantly more women (35 percent) than men (24 percent) exercise only once a week or less. When asked why they don't exercise more often, they are more likely than men to say they are just too tired

Willpower

• While both genders cite lack of willpower as the No. 1 barrier to change, women are more likely than men to cite lack of willpower as a barrier preventing them from making the lifestyle and behavior changes recommended by a health care provider (34 percent vs. 24 percent).
• When asked what they would need to change in order for their willpower to improve, women were more likely than men to say less fatigue/more energy (56 percent vs. 44 percent) and more confidence in their ability to improve their willpower (60 percent vs. 38 percent).
• Men are less likely to say they need encouragement from friends or family in order to improve their willpower (28 percent vs. 42 percent) and slightly more likely to say they need more money (43 percent vs. 39 percent). Women are more likely to say they need more time (37 percent vs. 29 percent).
• Six times as many women as men say that having more help with household chores would allow them to improve their willpower (23 percent vs. 4 percent).