Monthly Archives: October 2014

Health News - Psoriasis
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PUBLIC RELEASE DATE:

15-Oct-2014

Contact: Katie Delach katie.delach@uphs.upenn.edu 215-349-5964 University of Pennsylvania School of Medicine @PennMedNews

PHILADELPHIA Patients with more severe psoriasis are also more likely to have uncontrolled hypertension, according to new research by a team at the Perelman School of Medicine at the University of Pennsylvania. Through a cross-sectional study using information collected from a medical records database, the results provide further evidence of a strong link between psoriasis and hypertension. Full results are now available in JAMA Dermatology.

"Over the last several years, studies have shown that psoriasis, specifically severe psoriasis, is an independent risk factor for a variety of comorbidities, putting patients suffering with this common skin disease at an increased risk for other conditions such as heart attack and stroke," says Junko Takeshita, MD, PhD, clinical instructor in the department of Dermatology at Penn Medicine and co-first author on the study. "Knowing that psoriasis is tied to other health conditions, it's vital that we have a better understanding of the systemic effects it has on other areas of the body so that we can more closely monitor these patients and provide better and preventative care."

Defining uncontrolled hypertension as blood pressure measured as at least 140/90, the researchers found a clear relationship between psoriasis and uncontrolled hypertension in patients with a confirmed diagnosis of psoriasis. Additional finding indicate there is a significant dose-response relationship, meaning that the likelihood of uncontrolled hypertension increases with greater psoriasis severity. Results of the study reveal that the patients with the highest risk of having uncontrolled blood pressure, are those with moderate to severe psoriasis, which is defined as having at least three percent of one's body surface affected by the disease.

Takeshita and colleagues examined data from a random sample of psoriasis patients included in The Health Improvement Network (THIN), an electronic medical database based in the United Kingdom that collects demographic, diagnostic, treatment, and laboratory information from a broad representative sample of the UK population. Takeshita says the psoriasis diagnostic code in the database has been validated through extensive studies looking at the condition.

The researchers concentrated on a specific group within the THIN database called the Incident Health Outcomes and Psoriasis Events (iHOPE) cohort, a random sample of about 9000 patients with a confirmed diagnosis of psoriasis and disease severity classified by their general practitioners using objective measures, specifically body surface area involvement. This permitted a level of analysis not possible in previous studies.

"Most large electronic databases such as THIN do not have information such as body surface area involvement or other direct measures of psoriasis severity, and we usually have to use surrogate measures such as receipt of a treatment that is indicated for more severe psoriasis to define psoriasis severity," Takeshita explains. "The use of surrogate measures to define psoriasis severity is not ideal for multiple reasons. For example, we know that many patients with psoriasis go untreated, so using treatment to define psoriasis severity may incorrectly identify patients who truly have severe disease as having mild disease. Furthermore, when we use treatments to define psoriasis severity, we cannot separate effects of psoriasis itself from potential psoriasis treatment effects on blood pressure control. To our knowledge, ours is the first study to evaluate the effect of objectively determined psoriasis severity on blood pressure control."

Although the work strongly suggests a correlation between hypertension and psoriasis, the cross-sectional nature of the study doesn't allow one important issue to be addressed: the "chicken or egg" question of whether psoriasis may cause hypertension or whether the presence of hypertension contributes to psoriasis. Still, the present study provides an ideal starting point for that next investigative step.

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Penn Medicine researchers zero in on psoriasis-hypertension link

PUBLIC RELEASE DATE:

15-Oct-2014

Contact: Katie Delach katie.delach@uphs.upenn.edu 215-349-5964 The JAMA Network Journals @JAMA_current

Bottom Line: Patients with moderate and severe psoriasis have the greatest likelihood of uncontrolled hypertension compared to patients without psoriasis.

Author: Junko Takeshita, M.D., Ph.D., of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

Background: Psoriasis is a chronic inflammatory disease of the skin and cardiovascular risk factors, including hypertension, are more prevalent among patients with psoriasis compared to those patients without. Previous studies suggest that psoriasis, especially when it is more severe, is associated with an increased risk of cardiovascular events such as heart attack, stroke and death.

How the Study Was Conducted: The authors examined the effect of psoriasis and its severity (which was measured by affected body surface area) on blood pressure control among patients with hypertension. The study included 1,322 patients with psoriasis and hypertension and 11,977 controls with hypertension but without psoriasis.

Results: The authors discovered a "dose-response relationship" between uncontrolled hypertension and psoriasis severity, which means the likelihood of uncontrolled hypertension increased with severity of the skin condition. Hence, the likelihood of uncontrolled hypertension was greatest among patients with moderate and severe psoriasis. Patients with psoriasis were equally as likely to be receiving antihypertensive treatment as were patients without psoriasis. The likelihood of treatment did not differ by the severity of the psoriasis.

Discussion: "Adding to the currently limited understanding of the effects of comorbid disease on hypertension, our findings have important clinical implications, suggesting a need for more effective management of blood pressure in patients with psoriasis, especially those with more extensive skin involvement [greater than or equal to 3 percent of body surface area affected]."

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Uncontrolled hypertension highest among patients with moderate-to-severe psoriasis

Researchers suspect inflammation is the common denominator

WebMD News from HealthDay

By Amy Norton

HealthDay Reporter

WEDNESDAY, Oct. 15, 2014 (HealthDay News) -- People with more severe cases of psoriasis may be at increased risk of uncontrolled high blood pressure, a large study finds.

Researchers looking at over 13,000 adults in the United Kingdom found that those with severe psoriasis were 48 percent more likely to have poorly controlled blood pressure, versus people without the skin condition.

The findings, reported online Oct. 15 in the journal JAMA Dermatology, confirm an association between psoriasis and cardiovascular health. But the precise reasons are not clear, and a cause-and-effect link was not proven.

"We still don't fully understand why we see a higher prevalence of cardiovascular risk factors in people with psoriasis," said study leader Dr. Junko Takeshita, a clinical instructor of dermatology at the University of Pennsylvania in Philadelphia.

But, Takeshita said, chronic inflammation could be a common denominator.

People with psoriasis develop thick, scaly patches on their skin that are often itchy or sore. Experts believe the problem arises from an abnormal immune system attack on healthy skin cells -- a reaction that causes chronic inflammation. Chronic inflammation in the blood vessels is thought to contribute to high blood pressure ("hypertension"), heart disease and stroke.

Read more from the original source:
Psoriasis Tied to Raised Risk of Uncontrolled Blood Pressure