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Hypertension and psychosis
  1. Yauvani Sudarshan1,
  2. Bernard M Y Cheung2
  1. 1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  2. 2Department of Medicine, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Professor Bernard M Y Cheung, Department of Medicine, The University of Hong Kong, Hong Kong, China; mycheung{at}


Hypertension, a prevalent component of metabolic syndrome (MetS), is a well-known risk factor for cardiovascular diseases (CVD). Psychosis is a feature in the schizophrenia spectrum. Meta-analysis suggests that the prevalence of hypertension in schizophrenia and related disorders is 39%. This may be explained by a unidirectional association between hypertension and psychosis, in that psychosis can be a causative factor of hypertension via antipsychotic medication, inflammation and irregular autonomic nervous system activity through multiple mechanisms. Obesity is a side effect of antipsychotic medication and is a risk factor for hypertension. Obesity leads to raised blood pressure, atherosclerosis, increased triglyceride concentration and decreased high-density lipoprotein concentration. Inflammation accompanies hypertension and obesity. In recent years, the role of inflammation in the onset of psychosis has been increasingly recognised. It underlies the immune dysregulation observed in both schizophrenia and bipolar disorder. Interleukin-6, a marker and driver of inflammation, is related to obesity and plays a role in the pathogenesis of MetS and hypertension. The lack of preventive care of hypertension and other MetS risk factors for patients on antipsychotic medication is reflected in the high incidence of CVD in this population. It is important to detect and treat MetS and hypertension in patients with psychosis in order to reduce cardiovascular morbidity and mortality in this population.

  • hypertension
  • schizophrenia & psychotic disorders

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  • Contributors YS prepared the manuscript draft with important intellectual input from BC. All authors were involved in revising the draft manuscript. All authors approved the final manuscript.

  • Funding This study was funded by the Biomedical Sciences Internship Programme at the University of Hong Kong.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.