Caroline Helwick

June 02, 2010

June 2, 2010 (New Orleans, Louisiana) — Bipolar patients with mania may be at risk for hypertension and other cardiometabolic disorders, according to a single-center study that diagnosed the condition in nearly half of patients admitted for mania.

Obesity was observed in 35% of the population as well, reported Dale D'Mello, MD, Michigan State University in Lansing, at the American Psychiatric Association 2010 Annual Meeting.

"We found the prevalence of hypertension to be higher in this cohort admitted for acute mania than for the general population. An earlier age of onset of bipolar disorder was predictive of the future development of hypertension, and the presence of concurrent hypertension was associated with more severe mania ratings," Dr. D'Mello said.

Dr. Dale D'Mello

Patients with bipolar disorder experience a disproportionate burden of cardiometabolic disorders. The pathogenesis and clinical consequences of these comorbid medical conditions on the expression and course of bipolar disorder are not understood.

The purpose of the present study was to determine the prevalence and examine the clinical correlates of cardiometabolic disorders in patients hospitalized with bipolar disorder, he said.

The population included 99 patients hospitalized on an inpatient psychiatry unit for the treatment of bipolar manic and mixed states from 2002 to 2006. After stabilization, the patients completed a brief inventory that included demographic, disease, and treatment variables. A psychiatrist made the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis and completed the Young Mania Rating Scale.

The study showed that 45% of the patients admitted for mania or mixed states were hypertensive, compared with the 30.5% rate of hypertension in the general population, based on the National Health and Nutrition Examination Survey, Dr. D'Mello reported. He used the metabolic syndrome definition of hypertension (140/90 mm Hg).

The acute mania cohort also had a higher prevalence of dyslipidemia and diabetes, he added.

For the comparison between the hypertensive and normotensive patients, the patients with hypertension were older, with a mean age of 44 years vs 37 years for normotensive patients in the study. They were also more obese, with a mean body mass index of 33 vs 28 for the nonhypertensive group.

Interestingly, patients with hypertension had a significantly earlier mean age of onset of bipolar disorder — 24 vs 29 for normotensive patients (P = .05) — and achieved significantly higher mean mania ratings than the others — 40 vs 35 (P = .04).

"The finding of a higher severity score for persons with hypertension is new and surprising," Dr. D'Mello commented. "We wonder if the hypertension is an epiphenomenon of bipolar disorder, perhaps. And this is in the acute state. We don't know whether 6 months down the road when patients are stable, whether this association will still be seen."

Prakash Masand, MD, consulting professor of psychiatry at Duke University, Durham, North Carolina, viewed the poster and commented for Medscape Psychiatry that it is possible the 2 conditions — hypertension and acute mania — share some underlying factors, for instance, inflammatory factors.

It is conceivable and would be desirable, he said, that by preventing hypertension one might be able to modify the expression and outcome of persons with bipolar disorder, although much research would be necessary to show this.

Dr. D'Mello serves on the speakers' bureaus of AstraZeneca, Schering, and Pfizer. Dr. Prasand serves on the speakers' bureaus of Eli Lilly, Forest, GlaxoSmithKline, Janssen Cilag, Pfizer, Schering, and UCB Pharma; is a consultant for Dainippon Sumitomo, Eli Lilly, Pam Lab LLC, Pfizer, Sanofi Aventis, Schering, and UCB Pharma; and owns stock in Orexigen and Titan Pharmaceuticals Inc.

American Psychiatric Association 2010 Annual Meeting: Abstract NR4-17. Presented May 25, 2010.


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