Psoriasis and Hypertension Severity: Results from a Case-Control Study

Abstract

BackgroundEpidemiologic studies have provided new insights into the association between psoriasis and cardiovascular diseases. Previous population studies have examined hypertension frequency in psoriasis patients. However, the relationship between severity of hypertension and psoriasis has not been characterized.ObjectiveWe sought to investigate whether patients with psoriasis have more difficult-to-manage hypertension compared to non-psoriatic hypertensive patients.ApproachWe performed a case-control study using the University of California Davis electronic medical records. The cases were defined as patients diagnosed with both psoriasis and hypertension, and controls were defined as patients with hypertension and without psoriasis. In this identified population, 835 cases were matched on age, sex, and body mass index (BMI) to 2418 control patients.Key ResultsTreatment with multiple anti-hypertensives was significantly associated with the presence of psoriasis using univariate (p<0.0001) and multivariable analysis, after adjusting for diabetes, hyperlipidemia, and race (p<0.0001). Compared to hypertensive patients without psoriasis, psoriasis patients with hypertension were 5 times more likely to be on a monotherapy antihypertensive regimen (95% CI 3.607.05), 9.5 times more likely to be on dual antihypertensive therapy (95% CI 6.68–13.65), 16.5 times more likely to be on triple antihypertensive regimen (95% CI 11.01–24.84), and 19.9 times more likely to be on quadruple therapy or centrally-acting agent (95% CI 10.58–37.33) in multivariable analysis after adjusting for traditional cardiac risk factors.ConclusionsPsoriasis patients appear to have more difficult-to-control hypertension compared to non-psoriatic, hypertensive patients.

A Review of the Epidemiology of Cardiovascular Comorbidities in Psoriasis

“…In another retrospective case-control study, psoriasis patients with hypertension were found to have more severe hypertension and required more medications to control blood pressure when compared to the control group [24]. These study results reinforce an important need for dermatologists to routinely screen patients with psoriasis for hypertension.…”

Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many Comorbities – Clinical Remission with a Leishmania Amastigotes Vaccine, a Serendipity Finding

“…Compared to hypertensive patients without psoriasis, psoriasis patients with hypertension were 5 times more likely to be on a monotherapy antihypertensive regimen, 9.5 times more likely to be on dual antihypertensive therapy, 16.5 times more likely to be on triple antihypertensive regimen, and 19.9 times more likely to be on quadruple therapy or centrally-acting agent in multivariable analysis, after adjusting for traditional cardiac risk factors. Psoriasis patients appear to have more difficult-to-control hypertension compared to non-psoriatic, hypertensive patients (Armstrong et al, 2011).…”

Metabolic Features in Psoriasis

“…The pathogenesis of hypertension in psoriasis seems to be linked to increased production of angiotensinogen by adipose tissue, subsequently converted to angiotensin II through angiotensin converting enzyme (ACE) (Armstrong AW et al, 2011).…”

“…Angiotensin II not only promotes salt retention by kidney but also it regulates vascular tone, acting a vasoconstrictor and stimulates T-cell proliferation promoting inflammation and the development of atherosclerosis (Armstrong AW et al, 2011).…”

“…Greater levels of reactive oxygen species can damage endothelium-dependent vasodilation (Armstrong AW et al, 2011).…”