Hypertensive patients who have psoriasis may need stricter blood pressure control

By Sally Robertson, B.Sc.Oct 16 2014

People with hypertension who also have psoriasis may benefit from tighter blood pressure control, say researchers, particularly if their psoriasis is moderate or severe.

According to a new study published in JAMA Dermatology, psoriasis is independently associated with poorly controlled blood pressure and those with moderate to severe disease are at the greatest risk of uncontrolled hypertension.

Psoriasis is a chronic inflammatory skin disease and cardiovascular risk factors are known to be more prevalent among people who have the condition. Although previous studies have suggested that psoriasis increases the risk of cardiovascular events, how it affects hypertension control remains unclear.

For the current study, Junk Takeshita (University of Pennsylvania, Philadelphia) and colleagues examined the relationship between psoriasis and blood pressure control among 1,322 hypertensive patients who had psoriasis and 11,977 age-matched controls who had hypertension but no psoriasis. Data were drawn from The Health Improvement Network (THIN), an electronic database of medical records that is broadly representative of the UK’s general population.

Psoriasis severity was assessed according to the surface area of the body affected, with psoriasis classed as moderate or severe when it affected 3% or more of the body area. Uncontrolled blood pressure was defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher.

The researchers discovered a significant positive dose-dependent relationship between psoriasis severity and uncontrolled hypertension. Compared with hypertensive patients who did not have psoriasis, those with mild psoriasis were 3% less likely to have uncontrolled hypertension, while those with moderate or severe disease were 20% and 48% more likely (respectively) to have uncontrolled hypertension. These results were obtained after adjustment for age, gender, body mass index, comorbidity, smoking status, alcohol status and the use of blood pressure medications and anti-inflammatory drugs.

The team also found that the patients with psoriasis were no more likely to be receiving any antihypertensive medication than patients without the skin condition and that the likelihood of such treatment being received did not differ according to psoriasis severity.

Takeshita and colleagues conclude,

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