Impact of hypertension on vascular remodeling in patients with psoriatic arthritis

Abstract

We studied the impact of hypertension along with traditional and new cardiovascular risk factors on the structural and functional properties of arteries in psoriatic arthritis (PsA) patients. We examined 42 PsA subjects (aged 51±9 years) stratified according to hypertensive status (19 normotensive, PsA-NT and 23 hypertensives, PsA-HT). Thirty-eight normotensive subjects (C-NT) and 23 hypertensives (C-HT) comparable by age and sex served as controls. Mean carotid intima-media thickness (mean-IMT) and mean of the maximum IMT (M-Max) were evaluated by ultrasound in carotid artery segment bilaterally. Post-occlusion flow-mediated dilation (FMD) of the brachial artery was evaluated by ultrasonography. These parameters were correlated with risk factors, markers of inflammation and disease activity. Values of mean-IMT were higher in both groups of PsA patients compared with C-NT (0.68 mm in PsA-NT and 0.75 mm in PsA-HT versus 0.61 mm in C-NT). PsA-HT displayed higher M-Max (0.95 mm) versus both C-HT (0.71 mm) and PsA-NT (0.79 mm). FMD was impaired in PsA subjects compared with C-NT (5.7% in PsA-NT and 6.0% PsA-HT versus 9.3% in C-NT), whereas there was no difference among PsA-HT, PsA-NT, and C-HT groups. Values of carotid IMT were directly related to tumor necrosis factor (TNF)-α, osteoprotegerin (OPG), blood pressure and lipid profile levels. FMD showed an inverse relationship with TNF-α and blood pressure, but no correlation with lipids. In conclusion, PsA per se implies a pro-atherogenic remodeling, which is enhanced by the hypertensive status. TNF-α and OPG may have an independent role in the development of such vascular damage.

Atherosclerosis in Psoriatic Arthritis: A Multiparametric Analysis Using Imaging Technique and Laboratory Markers of Inflammation and Vascular Function

“…The prevalence of increased subclinical atherosclerosis has been studied previously in PsA through the assessment of CIMT and FMD, but the partial exclusion of traditional cardiovascular risk factors, cardiovascular events, or concomitant medications have led to ambiguous results. 5,16,17 Hence, we excluded PsA patients with traditional cardiovascular risk factors, manifest CVD or on medications likely to influence vascular function (TNF-α inhibitors, steroids, β blockers, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, statins, aldosterone antagonist, and peroxisome proliferator-activated receptor).…”

Carotid intima-media thickness in patients with mild or moderate psoriasis

“…demonstrated that carotid IMT was significantly higher in the PsA group compared to healthy controls and remained significant when PsA patients were divided into subgroups with and without risk factors for cardiovascular disease (CVD) [10]. When the carotid IMT cut-off point of 95 percentile for age, gender and race was included with the presence of known CVD risk factors (obesity, smoking, hypertension), an increase in carotid IMT was associated with an increase in the 10-year risk of coronary artery disease by 14% [10, 14–16]. It suggests that psoriatic arthritis is an independent risk factor for atherosclerosis.…”

Progression de l’athérosclérose chez les patients ayant un rhumatisme psoriasique malgré un traitement par anti-TNF-alpha : étude prospective observationnelle de 2 ans

“…Comme cela a été rapporté dans la littérature, le taux du TNF-␣ circulant augmenta après traitement anti-TNF-␣ [31,32]. En considérant que le TNF-␣ est un des plus importants médiateurs de l'inflammation et de la dysfonction endothéliale [33] et que et que l'EIM moyenne et la M-Max sont corrélées aux taux du TNF-␣ sérique de faç on significative [34], des niveaux éle-vés de TNF-␣ pourraient être responsables de la progression du dommage vasculaire dans le RP. En fait, l'évaluation du risque CV chez les patients ayant un RP semble être sous-estimée en utilisant les scores de risque habituels ; ainsi d'autres facteurs doivent expliquer la progression de l'athérosclérose malgré un traitement approprié [35].…”