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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.