CLINICAL HANDBOOK OF SCHIZOPHRENIA

430 VI. SPECIAL POPULATIONS AND PROBLEMSencourage lifestyle changes and appropriate medical management. This group of individualsis at especially high risk of serious complications of hypertension due to an underlyinggenetic vulnerability.Regular physical exercise is an important part of achieving and maintaining ahealthy blood pressure. Continuous prompting and encouragement are important inhelping patients begin and sustain an exercise program. The medical provider should beconsulted regarding a suitable level of exercise. In addition, if a person with hypertensionis overweight, then it is important to identify a strategy for sustainable weight loss. A nutritionistis an important resource for educating a person with schizophrenia about appropriatedietary changes. Dietary education should be practical and easy to understand,and include basic information on portion size, healthy food items, and easy-to-preparehealthy menus. Additional practical information includes where to find nutritious fooditems in the grocery store; how to read nutrition labels for important information aboutsalt, fat, and cholesterol content; and how to prepare low-fat meals.Preferably a person with hypertension should reduce the intake of food items thatare high in salt (e.g., salted chips and canned soups) or high in saturated fats (e.g., manymeat and dairy products). Diets that focus on fruits, vegetables, whole grains, and low-fatdairy products are generally good, such as the Dietary Approaches to Stop Hypertension(DASH) eating plan. Excessive amounts of alcohol can increase a person’s blood pressure.Addressing alcohol and substance use problems is important for effective hypertensionmanagement.When lifestyle measures alone do not reduce the blood pressure to a normal range,medications for hypertension are necessary. For some persons, medication and lifestylechanges may be started concurrently. Many antihypertensive medications exist, includingdiuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensinreceptor blockers. Certain antihypertensive medications, such as some diuretics andbeta-blockers, should be avoided by patients on antipsychotic medications because of therisk of heart-related complications. Consequently, to meet both medical and psychiatricneeds, and to minimize the risk of drug interactions, a team-based approach of both psychiatricand medical providers is desirable.Because hypertension usually is not associated with symptoms, it is sometimes hardto motivate patients to take their medications. For the same reason, persons with schizophreniaare likely more aware of the consequences of not taking psychiatric medicationsthan of not taking antihypertensive medications. However, the same medication adherencestrategies apply to both psychiatric and medical medications. For example, medicationadherence may be improved by placing the medicine container close to one’s toothbrushor using written reminders.When blood pressure is not in the normal range, or when the person experiencesantihypertensive medication side effects (e.g., weakness, dizziness, dry mouth, persistentcough, or sexual dysfunction), a change of medications should be considered. A personwith schizophrenia and hypertension who experiences side effects should be encouragedto report symptoms promptly to the medical provider. An alternative medication regimenthat is more tolerable may improve medication adherence.TABLE 41.3. Hypertension Lifestyle Changes• Diet modification (e.g., low-fat, low-salt)• Smoking cessation• Exercise• Weight loss, if obese• Alcohol screening or counseling