Drug-Induced Secondary Hypertension by Quetiapine Prescription in an Elderly Patient with Anxiety Disorder

Prescription of antipsychotic drugs is critical since they may cause hemodynamic changes, including hypertensive crisis,which is particularly important in patients with cardiovascular diseases. Quetiapine is an atypical antipsychotic approved for the treatment of schizophrenia, bipolar disorder, major depressive disorder, and anxietydisorder.1 The exact mechanism of action of this drug is unknown, but it is assumed that it antagonizes D2 and HT2-5 receptors. It may also have antagonizing effects on α2-5, α1, H1, D1, and HT1a receptors.2, 3Quetiapine has been reported to cause hypertension3, 4 which occurred in the case presented here. A 67-year-old married woman suffering from insomnia for about two months was referred to the psychiatrist one month ago and was prescribed Gabapentin 100/Hs and Quetiapine 12.5 mg Hs. After 24 hours, she suddenly had palpitation and high bloodpressure.Depression is common in patients with uncontrolled hypertension which may interfere with blood pressure control. Depression screening in patients with hypertension is a simple and cost-effective tool to improveoutcomes.5Both depressed and hypertensive patients experience increased sympathetic tone and increased secretion of adrenocorticotropic hormones and cortisol. Therefore, the interaction between depression and hypertension is pathophysiologically acceptable.5, 6The symptoms were controlled with sublingual captopril, but they often recurred in the afternoon. The blood pressure has been under the control for 20 years by a cardiologist and her Electrocardiogram (ECG) was normal. In the recent visit, these drugs were continued for up to 10 days; moreover, considering potential drug allergy, the drugs were discontinued and clonazepam 1 mg tablet was administered ¼ Bid.Next, the sleep state was improved, though a heart rate of up to 85 per minute and elevated blood pressure (up to systolic blood pressure of 16) occurred often in the afternoon.Biochemical tests were normal and the nephrologist didn’t report major abnormal findings (Table1). The patient was diagnosed with slightly elevated renin due to taking Losartan 50 in the morning and at night