Psoriasis Severity Linked to Uncontrolled Hypertension

Diedtra Henderson

October 27, 2014

Patients with psoriasis had a greater likelihood of suffering from uncontrolled hypertension, with higher risks seen among patients with moderate to severe psoriasis that affected more than 3% of the surface of their bodies, according to a population-based, cross-sectional study.

Junko Takeshita, MD, PhD, from the Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues report their findings in an article published online October 15 in JAMA Dermatology.

The authors write that some 2% to 4% of people suffer from psoriasis, a disease triggered by a glitch in the immune system and characterized by patches of thick, red skin. To tease out the effect of psoriasis and its severity on the control of blood pressure, Dr Takeshita and colleagues tapped an electronic medical records database that aggregates data from 415 practices and represents 7.5 million patients. They randomly sampled patients aged 25 to 64 years who had received at least one diagnostic code for psoriasis in the 2 years prior and whose diagnoses and disease severity were corroborated by general practitioners. Those patients were matched with psoriasis-free patients from the same practices who were of the same age.

The research team leveraged clinical guidelines that define uncontrolled blood pressure as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Of 8760 eligible patients, 1322 had a diagnosis of hypertension. Some 680 had mild psoriasis, 469 had moderate psoriasis, and 173 had severe psoriasis. Dr Takeshita and coauthors found a "significant dose-response relationship" between uncontrolled hypertension and psoriasis severity.

Compared with patients without psoriasis, patients with psoriasis had higher body mass index, were more likely to be current users of nonsteroidal anti-inflammatory drugs, and had higher prevalence of diabetes and cardiovascular disease, the authors write.

"After adjusting for age, sex, [body mass index], smoking and alcohol use status, the presence of comorbid conditions (diabetes mellitus, chronic kidney disease, hyperlipidemia, and cardiovascular disease), and current use of antihypertensive medications and [nonsteroidal anti-inflammatory drugs], the dose-response relationship between uncontrolled hypertension and objectively measured psoriasis severity remained significant," with odds ratios of 1.20 (95% confidence interval, 0.99 - 1.45) and 1.48 (95% confidence interval, 1.08 - 2.04), respectively, in patients with moderate and severe psoriasis. "The likelihood of uncontrolled hypertension was the greatest among patients with moderate and severe psoriasis," a group that represents roughly half of the patients with psoriasis whom UK general practitioners see, the authors continue.

Dr Takeshita told Medscape Medical News that there are key takeaway messages from the work both for clinicians and for patients.

"As dermatologists, we need to be aware of the other effects that psoriasis can have on the body, and the other comorbidities that come along with psoriasis," Dr Takeshita said. "Dermatologists need to be aware that we need to counsel our patients with psoriasis, especially patients with more severe psoriasis, that their blood pressure needs to be regularly tested [and] monitored."

Patients also can do their part by taking their medication and by making sure "they're proactive in discussing their blood pressure with their primary care physician and making sure their blood pressure is regularly checked," she added.

The study's findings are generalizable to American patients, Abby S. Van Voorhees, MD, chair of the National Psoriasis Foundation Medical Board, told Medscape Medical News. "I don't see any reason to think patients in the UK would be uniquely at risk for their hypertension," Dr Van Voorhees said. Because patients with psoriasis tend to think of themselves as otherwise healthy, that places dermatologists in the vanguard of helping guide their patients to clinicians who can address their cardiovascular condition, she noted.

"If we're going to be the first doctor they encounter, it's imperative we know what their blood pressure is, so we can encourage them to plug in with the appropriate doctor," she said.

The study authors call for additional research to ferret out the effect of chronic inflammatory disease on hypertension to determine whether more effective treatment of the cardiovascular problem affects the severity of psoriasis.

"Adding to the currently limited understanding of the effects of comorbid disease on hypertension, our findings have important clinical implications, suggesting a need for more effective management of blood pressure in patients with psoriasis, especially those with more extensive skin involvement (ie, ≥3% BSA affected)," the authors conclude.

Financial support for the study was provided by the National Heart, Lung, and Blood Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Two authors disclosed receiving payment for continuing medical education work related to psoriasis. One of these authors further disclosed receiving awards from the Dermatology Foundation and the National Psoriasis Foundation. The other author further disclosed being a paid consultant for Abbvie, Amgen Inc, Celgene Corp, Eli Lilly, Janssen Biologics (formerly Centocor), Merck, Novartis Corp, and Pfizer Inc and disclosed having existing or pending grants from Abbvie, Amgen, Eli Lilly, Genentech Inc, Janssen, Novartis, and Pfizer. The remaining authors and Dr Van Voorhees have disclosed no relevant financial relationships.

JAMA Dermatol. Published online October 15, 2014. Abstract

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