A new study published in JAMA Dermatology finds that patients with moderate and severe psoriasis have an increased risk for uncontrolled high blood pressure, compared with patients who do not have psoriasis.
Psoriasis is an inflammatory skin disease that affects 2-4% of the general population. Metabolic syndrome, high blood pressure, obesity and other cardiovascular risk factors are more common among people with psoriasis than those without the condition.
High blood pressure is a major risk factor for heart disease, but its relationship to psoriasis has not previously been investigated among patients who already have high blood pressure.
The researchers behind the new study – from the University of Pennsylvania Perelman School of Medicine, Philadelphia – wanted to see if the severity of psoriasis influences the severity of high blood pressure among patients who have both conditions.
Using a large, UK-based patient cohort – The Health Improvement Network, considered to be broadly representative of the population – the researchers examined data on 1,322 patients who had both psoriasis and high blood pressure and 11,977 controls who had high blood pressure but no psoriasis.
The results showed a “dose-response relationship” between uncontrolled high blood pressure and psoriasis severity. This means that the more severe a person’s psoriasis is, the more likely they are to have uncontrolled high blood pressure.blood pressure
The authors write:
“Adding to the currently limited understanding of the effects of comorbid disease on [high blood pressure], 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 (greater than or equal to 3% of body surface area affected).”
Factors such as age, sex, body mass index (BMI), smoking and alcohol status and other medical conditions that might have influenced the results – such as diabetes, kidney disease or heart disease – were all taken into account by the researchers.
Because the study sample was so large and representative of the population, the researchers believe that the results may be generalizable. However, this type of study is unable to show conclusively whether psoriasis severity influences blood pressure or whether blood pressure status influences the severity of psoriasis.
Another limitation of the study may be that the diagnoses of uncontrolled high blood pressure were made from single blood pressure measurements, rather than an aggregate of several blood pressure measurements. Therefore, high blood pressure may have been overestimated in some subjects.
The study also reports that patients both with and without psoriasis were equally likely to be receiving treatment for high blood pressure, and that the likelihood of treatment was not influenced by the severity of psoriasis.
The authors say that additional studies are needed to further investigate the effect of chronic inflammatory diseases – such as psoriasis – on high blood pressure. Research, they say, should also look at the mechanisms involved in blood pressure control among psoriasis patients, and at whether improved blood pressure management in patients affects the severity of their psoriasis.