Large Meta-Analysis Supports Link Between Psoriasis, Hypertension

Patients with psoriasis face an increased risk of hypertension, according to a new large-scale meta-analysis of more than 50,000 cases.

The report, published in the journal Medicine, offers strong support for a link long suggested in the scientific literature.

Tao Wu, MD, PhD, of the Department of Urology at the Affiliated Hospital of North Sichuan Medical College, in China, told The American Journal of Managed Care^® that the group’s interest in the question of psoriasis and hypertension started with the observations of one of the group’s members, Xi Duan, MD, a dermatologist. Duan had anecdotally noticed that many of her psoriasis patients also had hypertension. When the group researched existing literature on the issue, they found significant evidence of a link, but nothing that was conclusive.

“We found that this link (between psoriasis and hypertension) is also controversial,” Wu said. “Although most researchers consider that there is a relationship between them, other people hold the opposite view.”

Wu and colleagues decided to try to quantify the link (or lack thereof) in a more comprehensive manner by undertaking a massive meta-analysis that included adjustments for covariates.

They found a total of 16 studies that had been adjusted for covariates, and which encompassed some 50,291 cases of hypertension among 255,132 patients with psoriasis, and 76,547 cases of psoriasis within 814,631 controls. After adjusting for covariates, the data showed significant correlations, including that patients with psoriasis had a higher risk of hypertension compared to those without, and that patients with severe psoriasis had a higher risk of hypertension than those with mild psoriasis. The data also confirmed that the increased risk of hypertension in psoriasis patients held true for patients in both Europe and Asia.

“As for our findings, we are not very surprised, because this point of view has been proofed by some cohort studies,” Wu said. “What we have done is provide more convincing evidence for that.”

There are a number of potential factors that could be at play in the linkage, Wu and colleagues wrote.

“First of all, psoriasis itself might lead to stress, anxiety, depression, more likely to smoke, drink, lack of exercise, and lead to abnormal blood pressure, and moreover, drugs for psoriasis, such as cyclosporine and compound glycyrrhizin, might affect blood pressure, and diabetes mellitus and metabolic syndrome were also confounding factors associated with psoriasis and hypertension,” Wu and colleagues noted.

Though the etiology of psoriasis is not yet clearly defined, Wu and colleagues write that given the serious effect both psoriasis and hypertension can have on a patient’s life, all patients with psoriasis ought to undergo detailed screening for hypertension.

Wu said a significant amount of basic research has been done into the question of whether the treatment of one condition will improve the other. That research indicates that the link might lie in shared pathways such as systemic endothelial dysfunction, increased oxidative stress, and the altered renin-angiotensin system in patients with psoriasis.

“Since there is some common pathogenesis between the two diseases to some extent, from this point of view, we also think that treating 1 of the 2 diseases is of positive significance to the other, but this view still needs a lot of research and evidence to support,” Wu said.

Reference

Duan X, Junbo L, Mu Y, Liu T, Chen Y, Yu R, Xiong X, Wu T. A systematic review and meta-analysis of the association between psoriasis and hypertension with adjustment for covariates. Medicine. 2020;99:9(e19303).