Antihypertensive drug use and psoriasis: A systematic review, meta‐ and network meta‐analysis

Abstract

Aims Diverse genetic and/or external factors may induce psoriasis. Drug exposure is 1 such prominent external factor; antihypertensive drugs are reportedly associated with psoriasis, but study results have been inconsistent. In this context, we investigated the associations between antihypertensive drugs and incidence if psoriasis via a systematic literature review and meta‐analysis. Methods Literature search in databases such as PubMed, Embase and Web of Science was conducted on 8 January 2021, and obtained data were pooled for meta‐ and network meta‐analysis. Fixed‐ or random effect models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for evaluating the strength of the associations between antihypertensive drugs and psoriasis incidence. In addition to meta‐analysis, Bayesian network meta‐analysis was performed. ResultsThirteen eligible studies were included for meta‐analysis with 6 378 116 individuals and 8 studies for network meta‐analysis with 5 615 918 individuals. All antihypertensive drugs were significantly associated with psoriasis incidence. In a meta‐analysis, the pooled ORs were 1.67 (95% CI: 1.31–2.13) for angiotensin‐converting enzyme (ACE) inhibitors, 1.40 (95% CI: 1.20–1.63) for β‐blockers, 1.53 (95% CI: 1.23–1.89) for calcium‐channel blockers (CCBs), and 1.70 (95% CI: 1.40–2.06) for thiazide diuretics. For the comparative risks of psoriasis among antihypertensive drugs in the network meta‐analysis, ORs were 2.09 (95% CI: 1.39–3.18) for ACE inhibitors, 1.35 (95% CI: 0.99–1.91) for BBs, 1.53 (95% CI: 1.07–2.24) for CCBs and 1.80 (95% CI: 1.23–2.66) for thiazide diuretics. Conclusion This study confirmed the associations between antihypertensive drugs and psoriasis; ACE inhibitors, BBs, CCBs and thiazide diuretics increased the risk of psoriasis. Therefore, antihypertensive drug users should be carefully monitored for psoriasis.

Potential Role of the Skin in Hypertension Risk Through Water Conservation

“…41 Thus, changes in skin vessels may affect systemic blood pressure. However, some antihypertensive drugs have been reported to increase the risk of psoriasis, [42][43][44] and therefore, further basic and clinical research regarding blood pressure control in patients with psoriasis is merited. These findings also suggest that the concepts of water loss as a trigger and subsequent water conservation may be important for an understanding of the pathogenesis of hypertension.…”

“…41 Thus, changes in skin vessels may affect systemic blood pressure. However, some antihypertensive drugs have been reported to increase the risk of psoriasis, 42–44 and therefore, further basic and clinical research regarding blood pressure control in patients with psoriasis is merited.…”

Secukinumab Loss of Efficacy Is Perfectly Counteracted by the Introduction of Combination Therapy (Rescue Therapy): Data from a Multicenter Real-Life Study in a Cohort of Italian Psoriatic Patients That Avoided Secukinumab Switching

“…Conversely, patients were excluded in case of (a) type of psoriasis different from or concomitant with plaque psoriasis (i.e., pustular psoriasis), (b) undergoing fasting of particular diet regimens (i.e., intermitten circadian fasting), (c) addictions (i.e., drugs [67] or alcohol abuse (Alcohol Use Disorders Identification Test (AUDIT > 7)) [68], (d) chronic infectious diseases (i.e., tuberculosis, HIV, hepatitis B and C) [14,15,49], e) use of drugs capable to trigger plaque psoriasis flares [68][69][70], f) patients with persistent itch during monotherapy (persistent itch Visual Analogue Scale (VAS) > 4) [71][72][73].…”

Association between sodium–glucose co-transporter 2 inhibitors and risk of psoriasis in patients with diabetes mellitus: a nationwide population-based cohort study

“…7 As numerous medications can reportedly aggravate psoriasis, dermatologists need to have an understanding of these potential interactions. 8 Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with psoriasis and is also a reported risk factor for psoriasis. 9 However, the interaction between antidiabetic agents and psoriasis has yet to be extensively investigated.…”

“…Owing to these comorbid diseases, patients with psoriasis are more likely to experience polypharmacy 7 . As numerous medications can reportedly aggravate psoriasis, dermatologists need to have an understanding of these potential interactions 8 …”