Hypertension, Antihypertensive Medication Use, and Risk of Psoriasis | Dermatology | JAMA Dermatology | JAMA Network
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Griffiths  CE, Barker  JN.  Pathogenesis and clinical features of psoriasis.  Lancet. 2007;370(9583):263-271.PubMedGoogle ScholarCrossref
Lowes  MA, Bowcock  AM, Krueger  JG.  Pathogenesis and therapy of psoriasis.  Nature. 2007;445(7130):866-873.PubMedGoogle ScholarCrossref
Schön  MP, Boehncke  WH.  Psoriasis.  N Engl J Med. 2005;352(18):1899-1912.PubMedGoogle ScholarCrossref
Patel  RV, Lebwohl  M.  In the clinic: psoriasis .  Ann Intern Med. 2011;155(3):ITC-21–ITC2-15.PubMedGoogle Scholar
Javitz  HS, Ward  MM, Farber  E, Nail  L, Vallow  SG.  The direct cost of care for psoriasis and psoriatic arthritis in the United States.  J Am Acad Dermatol. 2002;46(6):850-860.PubMedGoogle ScholarCrossref
Gelfand  JM, Neimann  AL, Shin  DB, Wang  X, Margolis  DJ, Troxel  AB.  Risk of myocardial infarction in patients with psoriasis.  JAMA. 2006;296(14):1735-1741.PubMedGoogle ScholarCrossref
Gelfand  JM, Dommasch  ED, Shin  DB,  et al.  The risk of stroke in patients with psoriasis.  J Invest Dermatol. 2009;129(10):2411-2418.PubMedGoogle ScholarCrossref
Li  WQ, Han  JL, Manson  JE,  et al.  Psoriasis and risk of nonfatal cardiovascular disease in U.S. women: a cohort study.  Br J Dermatol. 2012;166(4):811-818.PubMedGoogle ScholarCrossref
Armesto  S, Coto-Segura  P, Osuna  CG, Camblor  PM, Santos-Juanes  J.  Psoriasis and hypertension: a case-control study.  J Eur Acad Dermatol Venereol. 2012;26(6):785-788.PubMedGoogle ScholarCrossref
Armstrong  AW, Lin  SW, Chambers  CJ, Sockolov  ME, Chin  DL.  Psoriasis and hypertension severity: results from a case-control study.  PLoS One. 2011;6(3):e18227. doi:10.1371/journal.pone.0018227.PubMedGoogle ScholarCrossref
Cohen  AD, Sherf  M, Vidavsky  L, Vardy  DA, Shapiro  J, Meyerovitch  J.  Association between psoriasis and the metabolic syndrome: a cross-sectional study.  Dermatology. 2008;216(2):152-155.PubMedGoogle ScholarCrossref
Cohen  AD, Weitzman  D, Dreiher  J.  Psoriasis and hypertension: a case-control study.  Acta Derm Venereol. 2010;90(1):23-26.PubMedGoogle ScholarCrossref
Neimann  AL, Shin  DB, Wang  X, Margolis  DJ, Troxel  AB, Gelfand  JM.  Prevalence of cardiovascular risk factors in patients with psoriasis.  J Am Acad Dermatol. 2006;55(5):829-835.PubMedGoogle ScholarCrossref
Sommer  DM, Jenisch  S, Suchan  M, Christophers  E, Weichenthal  M.  Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis.  Arch Dermatol Res. 2006;298(7):321-328.PubMedGoogle ScholarCrossref
Qureshi  AA, Choi  HK, Setty  AR, Curhan  GC.  Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses.  Arch Dermatol. 2009;145(4):379-382.PubMedGoogle ScholarCrossref
Brauchli  YB, Jick  SS, Curtin  F, Meier  CR.  Association between β-blockers, other antihypertensive drugs and psoriasis: population-based case-control study.  Br J Dermatol. 2008;158(6):1299-1307.PubMedGoogle ScholarCrossref
Cohen  AD, Bonneh  DY, Reuveni  H, Vardy  DA, Naggan  L, Halevy  S.  Drug exposure and psoriasis vulgaris: case-control and case-crossover studies.  Acta Derm Venereol. 2005;85(4):299-303.PubMedGoogle ScholarCrossref
Cohen  AD, Kagen  M, Friger  M, Halevy  S.  Calcium channel blockers intake and psoriasis: a case-control study.  Acta Derm Venereol. 2001;81(5):347-349.PubMedGoogle ScholarCrossref
Waqar  S, Sarkar  PK.  Exacerbation of psoriasis with β-blocker therapy.  CMAJ. 2009;181(1-2):60. doi:10.1503/cmaj.081433.PubMedGoogle ScholarCrossref
Wolkenstein  P, Revuz  J, Roujeau  JC, Bonnelye  G, Grob  JJ, Bastuji-Garin  S; French Society of Dermatology.  Psoriasis in France and associated risk factors: results of a case-control study based on a large community survey.  Dermatology. 2009;218(2):103-109.PubMedGoogle ScholarCrossref
Milavec-Puretić  V, Mance  M, Ceović  R, Lipozenčić  J.  Drug induced psoriasis.  Acta Dermatovenerol Croat. 2011;19(1):39-42.PubMedGoogle Scholar
Dominguez  PL, Assarpour  A, Kuo  H, Holt  EW, Tyler  S, Qureshi  AA.  Development and pilot-testing of a psoriasis screening tool.  Br J Dermatol. 2009;161(4):778-784.PubMedGoogle ScholarCrossref
Colditz  GA, Martin  P, Stampfer  MJ,  et al.  Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women.  Am J Epidemiol. 1986;123(5):894-900.PubMedGoogle Scholar
Austin  LM, Ozawa  M, Kikuchi  T, Walters  IB, Krueger  JG.  The majority of epidermal T cells in Psoriasis vulgaris lesions can produce type 1 cytokines, interferon-γ, interleukin-2, and tumor necrosis factor-α, defining TC1 (cytotoxic T lymphocyte) and TH1 effector populations: a type 1 differentiation bias is also measured in circulating blood T cells in psoriatic patients.  J Invest Dermatol. 1999;113(5):752-759.PubMedGoogle ScholarCrossref
Serg  M, Kampus  P, Kals  J,  et al.  Nebivolol and metoprolol: long-term effects on inflammation and oxidative stress in essential hypertension.  Scand J Clin Lab Invest. 2012;72(5):427-432.PubMedGoogle ScholarCrossref
Schiffrin  EL.  The immune system: role in hypertension.  Can J Cardiol. 2013;29(5):543-548.PubMedGoogle ScholarCrossref
Lakoski  SG, Cushman  M, Siscovick  DS,  et al.  The relationship between inflammation, obesity and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis (MESA).  J Hum Hypertens. 2011;25(2):73-79.PubMedGoogle ScholarCrossref
Zhang  Y, Thompson  AM, Tong  W,  et al.  Biomarkers of inflammation and endothelial dysfunction and risk of hypertension among Inner Mongolians in China.  J Hypertens. 2010;28(1):35-40.PubMedGoogle ScholarCrossref
Fry  L, Baker  BS.  Triggering psoriasis: the role of infections and medications.  Clin Dermatol. 2007;25(6):606-615.PubMedGoogle ScholarCrossref
O’Brien  M, Koo  J.  The mechanism of lithium and β-blocking agents in inducing and exacerbating psoriasis.  J Drugs Dermatol. 2006;5(5):426-432.PubMedGoogle Scholar
Ockenfels  HM, Nussbaum  G, Schultewolter  T, Mertins  K, Wagner  SN, Goos  M.  Tyrosine phosphorylation in psoriatic T cells is modulated by drugs that induce or improve psoriasis.  Dermatology. 1995;191(3):217-225.PubMedGoogle ScholarCrossref
Kim  GK, Del Rosso  JQ.  Drug-provoked psoriasis: is it drug induced or drug aggravated? understanding pathophysiology and clinical relevance.  J Clin Aesthet Dermatol. 2010;3(1):32-38.PubMedGoogle Scholar
Li  W, Han  J, Hu  FB, Curhan  GC, Qureshi  AA.  Psoriasis and risk of type 2 diabetes among women and men in the United States: a population-based cohort study.  J Invest Dermatol. 2012;132(2):291-298.PubMedGoogle ScholarCrossref
Original Investigation
September 2014

Hypertension, Antihypertensive Medication Use, and Risk of Psoriasis

Author Affiliations
  • 1Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 2Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 3Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 4Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
  • 5Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis
  • 6Department of Dermatology, School of Medicine, Indiana University, Indianapolis
JAMA Dermatol. 2014;150(9):957-963. doi:10.1001/jamadermatol.2013.9957

Importance  Individuals with psoriasis have an elevated risk of hypertension, and antihypertensive medications, especially β-blockers, have been linked to psoriasis development. However, the association of prior existing hypertension and antihypertensive medications with risk of incident psoriasis has not been assessed using prospective data.

Objective  To evaluate the association of hypertension and antihypertensive medications with risk of psoriasis.

Design, Setting, and Participants  We performed a prospective cohort study (June 1, 1996, to June 1, 2008) of 77 728 US women from the Nurses’ Health Study who provided biennially updated data on hypertension and antihypertensive medications.

Main Outcomes and Measures  Physician-diagnosed psoriasis.

Results  A total of 843 incident psoriasis cases were documented during 1 066 339 person-years of follow-up. Compared with normotensive women, women with a hypertension duration of 6 years or more were at a higher risk of developing psoriasis (hazard ratio [HR], 1.27; 95% CI, 1.03-1.57). In stratified analysis, the risk of psoriasis was higher among hypertensive women without medication use (HR, 1.49; 95% CI, 1.15-1.92) and among hypertensive women with current medication use (HR, 1.31; 95% CI, 1.10-1.55) when compared with normotensive participants without medication use. Compared with women who never used β-blockers, the multivariate HRs for psoriasis for women who regularly used β-blockers were 1.11 (95% CI, 0.82-1.51) for 1 to 2 years of use, 1.06 (95% CI, 0.79-1.40) for 3 to 5 years of use, and 1.39 (95% CI, 1.11-1.73) for 6 years or more of use (P for trend = .009). No association was found between use of other individual antihypertensive drugs and risk of psoriasis.

Conclusions and Relevance  Long-term hypertensive status is associated with an increased risk of psoriasis. Long-term regular use of β-blockers may also increase the risk of psoriasis.