Severe psoriasis increases uncontrolled hypertension risk by nearly 50%

More psoriasis sufferers are at risk for elevated blood pressure and uncontrolled hypertension, researchers found. The findings, published online Oct. 15 in JAMA: Dermatology, suggest a dose-response relationship between more severe psoriasis and hypertension compared with patients without psoriasis.

Using data available through Great Britain’s Health Improvement Network (THIN), Junko Takeshita, MD, PhD, of the Department of Dermatology at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, and colleagues created comparative cohorts of psoriasis patients with and without hypertension and hypertension sufferers with and without psoriasis. Patients included in the study’s psoriasis cohorts had physician-confirmed psoriasis diagnosis and electronically recorded blood pressure measurements available through THIN.

Psoriasis severity correlated to the percentage of the body covered by lesions; 2 percent or less was considered mild, 3 percent to 10 percent was considered moderate, and more than 10 percent was considered severe.

The THIN network captured EHR data for 7.5 million patients from 415 participating practices. A random sampling and practitioner survey yielded 10,026 psoriasis patients to the Incident Health Outcomes and Psoriasis Events cohort. Physicians diagnosed hypertension in 15.1 percent of the psoriasis cohort. Among hypertensive patients with psoriasis, 51.4 percent, 35.5 percent and 13.1 percent had mild, moderate, and severe psoriasis, respectively. Psoriatic arthritis patients represented 9.2 percent of the cohort.

Compared with patients without psoriasis, more psoriasis patients were smokers, had a history of cyclosporine or corticosteroid use, were on nonsteroidal anti-inflammatory drugs and quadruple antihypertensive therapy. Patients with psoriasis also had higher prevalence of cardiovascular disease and diabetes.

More than half of psoriasis sufferers in each of the three severities had uncontrolled hypertension, with severity increasing those numbers. More than 59 percent of severe psoriasis patients had uncontrolled hypertension. Odds leaned toward a dose response relationship between uncontrolled hypertension and psoriasis severity (odds ratio: 0.97 in mild psoriasis, 1.20 in moderate psoriasis and 1.48 in severe psoriasis). However, the research team found that patients with psoriasis were as likely to be receiving antihypertensive treatment as patients without, and showed no difference in regimen based on psoriasis severity.

While Takeshita et al suggested the relationship may include overexpression of endothelin 1, increased oxidative stress, inflammation or upregulation of renin-angiotensin, they could not confirm that with the available data. Further, they noted cyclosporine may have some effect as a treatment for psoriasis with known blood pressure impact. However, excluding patients for cyclosporine use did not make a difference to overall hypertension risk.

Future studies, suggested Takeshita et al, focused on chronic inflammatory disease mechanisms and the effect on and management of hypertension were needed along with development of more effective blood pressure management for psoriasis patients.