1. A history of hypertension for 6 or more years was linked with an increased risk of psoriasis in US women.
2. Women with regular β-blocker usage were at higher risk of psoriasis than those who had never used β-blockers.
Evidence Rating Level: 2 (Good)
Study Rundown: Psoriasis is a systemic disease associated with chronic inflammation secondary to T-cell-immune-mediated hyperproliferation of keratinocytes. It has been associated with an increased risk of hypertension and cardiovascular disease, but data involving the elevated risk of psoriasis as a result of hypertension and medication use has been limited. Thus, the authors sought to address this hypothesis and found that women with chronic hypertension of 6 or more years were more likely to develop psoriasis than normotensive women. Additionally long-term use of β-blockers may also be associated with increased risk of psoriasis. Strengths of this study included the use of registered nurses as the population, which added to the accuracy and validity of self-reported results. However, this same feature may have limited the study’s generalization to other populations.
In-Depth [prospective cohort]: This study followed 843 incident psoriasis cases in female registered nurses between the ages of 30 and 55 years using the Nurses’ Heath Study. Physician-diagnosed hypertension and regular antihypertensive medication use were reported and assessed using biennial questionnaires. Additionally, covariates such as weight, smoking, cardiovascular disease, hypercholesterolemia, type 2 diabetes mellitus, menopausal status, postmenopausal hormone use, nonsteroidal anti-inflammatory drug use, multivitamin use, height, body mass index, alcohol intake, and physical activity were collected through follow-ups. Cox proportional hazards regression model analysis was used to estimate incident psoriasis associated with hypertension and medications. Results indicated that women with chronic hypertension of 6 years or more were at a higher risk of developing psoriasis when compared to normotensive women (HR, 1.27; 95% CI, 1.03-1.57). This remained true for women who regularly took antihypertensive medications and for those who did not. Lastly, women who specifically took β-blockers for 6 or more years were found to be at higher risk for developing psoriasis (HR, 1.39; 95% CI, 1.11-1.73, P = 0.009).
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