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Psoriasis severity linked to odds of uncontrolled hypertension
Among patients with hypertension, those with psoriasis were more likely to have uncontrolled hypertension, with the odds of uncontrolled hypertension increasing with the severity of psoriasis, according to a new report.
Researchers conducted a population-based, cross-sectional study in a prospective cohort drawn from the Health Improvement Network database in the United Kingdom. They identified 1,322 patients aged 25 to 64 years with hypertension and psoriasis and 11,977 age- and practice-matched controls with hypertension and no psoriasis.
The group with psoriasis was stratified by severity of psoriasis based on percentage of body area affected. Mild psoriasis was defined as body surface area ≤2%; moderate psoriasis as body surface area 3% to 10%; and severe psoriasis as body surface area >10%. The primary outcome, uncontrolled hypertension, was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg.
Junko Takeshita, MD, PhD, and colleagues found that compared with patients without psoriasis, those with psoriasis had a higher median BMI (P<.001), were more likely to be current or former smokers (P<.001), were more likely to have used cyclosporine (P<.001) or systemic corticosteroids (P=.002), were more likely to be a current user of a nonsteroidal anti-inflammatory drug (P<.001) and were more likely receive quadruple therapy and/or a centrally acting agent for hypertension (P=.01).
In addition, the prevalence of diabetes (P<.001) and CVD (P=.04) was higher in patients with psoriasis compared with those without it.
In an unadjusted analysis, 50.6% of patients with mild psoriasis, 56.5% with moderate psoriasis and 59.5% with severe psoriasis had uncontrolled hypertension (P=.02).
After controlling for age, sex, BMI, smoking, alcohol use, presence of comorbid conditions, current use of antihypertensive medications and current use of NSAIDs, the researchers observed a dose-response relationship between uncontrolled hypertension and psoriasis severity (mild psoriasis, adjusted OR=0.97; 95% CI, 0.82-1.14; moderate psoriasis, adjusted OR=1.2; 95% CI, 0.99-1.45; severe psoriasis, adjusted OR=1.48; 95% CI, 1.08-2.04).
They also observed an increased likelihood of uncontrolled hypertension among patients with psoriasis (adjusted OR=1.1; 95% CI, 0.98-1.24).
Patients with psoriasis were just as likely to receive antihypertensive therapy as those without psoriasis (OR=1.01; 95% CI, 0.86-1.18). There was no trend between severity of psoriasis and likelihood of receiving antihypertensive therapy (P=.38).
“Our data suggest a need for more effective [BP] management, particularly among patients with more severe psoriasis,” Takeshita, from the department of dermatology at University of Pennsylvania Perelman School of Medicine, and colleagues wrote.
Disclosure: The study was funded by the NHLBI, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a Dermatology Foundation Career Development Award and a National Psoriasis Foundation Fellowship Award. See the full study for a list of the researchers’ relevant financial disclosures.