Orthostatic hypotension prevalence in patients with schizophrenia receiving antipsychotic treatment

Effectively managing hypertension in patients with schizophrenia presents a unique clinical challenge, particularly due to the high prevalence of antipsychotic-induced orthostatic hypotension (OH). This meta-analysis quantifies the burden of OH and identifies key risk factors to inform integrated cardiovascular care. We systematically reviewed observational studies reporting OH in adults with schizophrenia receiving antipsychotics. Data from four studies (n=1,248) were pooled using a random-effects model. The overall prevalence of OH was 11.7% (95% CI: 3.8–23.5%). Method of assessment was a critical moderator; active standing tests yielded a significantly higher prevalence (20.4%, 95% CI: 17.1–23.9%) than passive adverse event reporting (3.4%, 95% CI: 1.8–5.8%). Significant risk factors included comorbid hypertension (OR=1.82), psychotropic polypharmacy (OR=3.05), and older age (OR=2.48). These results reveal that approximately one in nine patients is affected, with routine monitoring likely missing a substantial number of cases. The strong link between OH and pre-existing hypertension creates a complex therapeutic landscape where treatment must balance the opposing risks of drug-induced postural drops and sustained elevated blood pressure. Proactive surveillance with standardized orthostatic testing, especially in high-risk patients, is essential. This evidence supports the need for collaborative treatment models that concurrently optimize psychiatric and cardiovascular outcomes, ensuring that hypertension management in schizophrenia is both effective and safe.