High blood pressure risk in psoriasis, psoriatic arthritis

Studies have shown that patients with psoriasis have an increased risk of poorly controlled hypertension.(©CreateJobs51/Shutterstock.com)

Psoriasis and psoriatic arthritis are relatively common immune mediated diseases. The increase in cardiovascular disease associated with psoriatic disease is well established. Interestingly, some studies suggest a stronger link between psoriatic arthritis and cardiovascular disease.

Hypertension is a major risk factor for the development of cardiovascular disease. It is therefore considered an important modifiable risk factor in the development of cardiovascular disease. Previous studies have shown that patients with psoriasis have an increased risk of poorly controlled hypertension. Furthermore, there appears to be an increased prevalence of hypertension in patients with psoriatic arthritis even after adjusting for traditional cardiovascular risk factors.

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A group of collaborating physicians from Hospital Universitario Central de Asturias (HUCA), Spain, led by Dr. Ruben Queiro performed an observational cross-sectional study to analyze the comparative prevalence of hypertension in psoriatic disease.

The patient cohort was from a multidisciplinary (rheumatology/dermatology), single center clinic, in a university hospital in Spain. 290 patients with psoriatic arthritis and 310 patients with psoriasis (in the absence of psoriatic arthritis) were included. For the purpose of the study hypertension was defined as 140/90 on two separate days during a one month period or the chronic use of antihypertensive medication.

The study cohort was composed of 324 men and 276 women with a mean age of 53 ± 12 years. The study results showed the following: 144/600 patients had hypertension (24%). The mean age at onset of psoriasis and arthritis was significantly higher in the hypertension population  (39 ± 17 in HBP vs. 26 ± 16 years in non-HBP, p < 0.01, 49 ± 17 in HBP vs. 41 ± 14 years in non-HBP, p < 0.01). The mean body weight and BMI were significantly higher in HBP patients (83 ± 16 in HBP vs. 77 ± 15 kg in non-HBP, p < 0.01, 30.2 ± 4.9 in HBP vs. 27 ± 4.4 in non-HBP, p < 0.01).

Hypertension and dyslipidemia were more common in psoriatic arthritis than in psoriasis (29% vs. 18%, OR 1.7, 95%CI 1.25–2.50, p < 0.01, 28% vs. 13.5%, OR 2.5, 95 %CI 1.7–3.3, p < 0.01). However, obesity and tobacco use were more prevalent among the psoriasis group than the PsA group (36.5% vs. 27.6%, OR 1.5, 95%CI 1.1–2.1, p < 0.05, 34.5% vs. 27.2%, OR 1.4, 95 %CI 1.0–2.0, p < 0.05). Surprisingly there were more smokers among nonhypertensive patients (36% vs. 22%, p < 0.01).

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No differences were detected between patients with or without hypertension in relation to the duration of illness, HLA-B*27 or consumption of systemic medications for treatment of psoriatic disease. The variables significantly associated with hypertension in the univariate analysis were an age at onset of psoriasis above 40 years (OR, 4.1), age at onset of arthritis above 40 years (OR, 2.6), low educational level (OR, 4.9), family history of PsA (OR, 2.9), pustular psoriasis (OR, 3.6), PASI > 10 (OR, 3.4), polyarthritis during follow-up (OR, 1.8), diabetes (OR, 17.2), obesity (OR, 3.9), ex-smokers (OR, 2.2), ischemic heart disease (OR, 4.9), stroke (OR, 8.7) and peripheral vascular disease (OR, 12.2) with a p value of < 0.10.

This study reaffirms that psoriatic arthritis has a higher prevalence of hypertension than psoriasis without psoriatic arthritis. It is postulated that increased inflammatory burden associated with psoriatic arthritis may drive hypertension and increased prevalence of cardiovascular disease. This may be modulated by inflammatory cytokines such as IL-17, overexpression of endothelin I,  or upregulation of renin-angiotensin signaling. Judicious management of traditional cardiovascular risk factors will hopefully improve mortality in psoriatic patients.

The study also indicates that psoriasis patients who are overweight or who have later-onset disease may be more likely to experience hypertension. To improve mortality in psoriatic patients, therefore, it is important for dermatologists to ensure these patients are seeing primary care physicians who can monitor their blood pressure.

READ MORE: Articles on comorbidities associated with plaque psoriasis

References:

Queiro R, Lorenzo A, Tejón P, Pardo E, Coto P. Hypertension is associated with increased age at the onset of psoriasis and a higher body mass index in psoriatic disease. Clin Rheumatol. 2019;38(8):2063-2068.