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).
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.
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.