Blood pressure in bipolar disorder: evidence of elevated pulse pressure and associations between mean pressure and mood instability

• Published in: International Journal of Bipolar Disorders Vol. 9; no. 1; p. 5
• Main Authors: McGowan, Niall M., Nichols, Molly, Bilderbeck, Amy C., Goodwin, Guy M., Saunders, Kate E. A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2021; Springer Nature B.V; SpringerOpen
• Subjects: Behavioral Therapy; Bipolar disorder; Blood pressure; Borderline personality disorder; Clinical Psychology; Ecological momentary assessment; Medicine; Medicine & Public Health; Mood instability; Neurology; Psychiatry; Psychopharmacology; Psychotherapy; Ecological momentary assessment; Bipolar disorder; Blood pressure; Borderline personality disorder; Mood instability
• ISSN: 2194-7511; 2194-7511
• DOI: 10.1186/s40345-020-00209-x

Background Bipolar disorder (BD) is associated with excess and premature cardiovascular mortality. Elevated blood pressure (BP) is a leading contributor to cardiovascular risk. However, few studies have examined BP in BD in comparison to other psychiatric disorders. Furthermore, the association between BP and mood instability is not presently clear despite increasing interest in repurposing existing antihypertensive medications as possible novel BD treatments. Thus we examined BP differences between BD and borderline personality disorder (BPD), a disorder with a similar symptom profile through chronic mood instability. Methods A total of 106 adults (38 BD, 25 BPD, and 43 healthy controls), evaluated in the Automated Monitoring of Symptom Severity (AMoSS) study, completed a week-long home blood pressure monitoring assessment and ecological momentary assessment of mood. We examined group-wise differences in mean BP and BP variability and their association with mood instability. Results BD individuals had a significantly wider resting pulse pressure (40.8 ± 7.4, mmHg) compared to BPD (35.7 ± 5.3, mmHg, P = 0.03) and control participants (37.3 ± 6.3, mmHg, P = 0.036). Systolic BP was negatively associated with sad mood instability, and all measures of mean BP (systolic, diastolic, and mean arterial pressure) were negatively associated with positive mood instability. Conclusions This study demonstrates BP differences between BD and healthy and clinical controls that are within a normotensive range. Early pulse pressure widening may be a modifiable pathophysiological feature of BD that confers later cardiovascular risk. BP may be an important transdiagnostic predictor of mood instability and a potential explicit treatment target.