Psoriasis, an inflammatory disease that causes scaly lesions on the skin, is associated with a host of other chronic health conditions, most notably psoriatic arthritis.
But there’s a medical problem related to psoriasis that may go overlooked: hypertension, or high blood pressure.
Blood pressure measures the force of blood as it pushes against the artery walls. High blood pressure — 130/80 millimeters of mercury (mmHg) or higher — is a significant risk factor for
heart disease.
If you have psoriasis, it’s important to talk with your doctor about hypertension and what you can do to lower your risk.
Research has found that people with psoriasis have an increased risk of hypertension, when compared with those without the condition, and the prevalence of hypertension in people with severe psoriasis is higher than in those with mild psoriasis.
“Patients with psoriasis typically have higher high blood pressure compared to the general population,” says Joel Gelfand, MD, vice chair of clinical research and medical director in the dermatology clinical studies unit at Penn Medicine in Philadelphia. “It is known that as the body surface area of psoriasis increases, the likelihood of achieving adequate blood pressure control among people with hypertension goes down.”
Researchers note that the chronic inflammation associated with psoriasis may contribute to endothelial dysfunction (when the large blood vessels on the heart’s surface constrict instead of opening) and arterial stiffness, which are risk factors for hypertension.
Still, the connection between psoriasis and high blood pressure is complex and not fully understood. “It is not known if psoriasis itself causes hypertension or if the relationship is caused by other risk factors such as obesity, smoking, or diet,” says Dr. Gelfand.
People with psoriasis appear to be especially prone to other risk factors for high blood pressure such as insulin resistance and diabetes, Gelfand says.
Psoriasis is also linked with metabolic syndrome, “and this is probably due to inflammation,” says Jessica Kaffenberger, MD, division director of medical dermatology at The Ohio State University Wexner Medical Center in Columbus.
Metabolic syndrome is a cluster of symptoms that raise heart disease risk. High blood pressure is one of the five symptoms of metabolic syndrome, along with abdominal obesity, impaired glucose regulation, high triglycerides, and reduced HDL ("good") cholesterol.
“When you have psoriasis, the inflammation causes or is associated with many of the conditions [such as high blood pressure] that lead to heart attacks,” says Mark Lebwohl, MD, professor of dermatology and dean for clinical therapeutics at the Icahn School of Medicine at Mount Sinai in New York City. “If you look at the frequency of heart attacks in patients with inflammation, it’s higher.”
There is now evidence that treating psoriasis improves hypertension and reduces heart attack risk.
Some biologic drugs for psoriasis may significantly reduce the risk of heart attack. A class of biological therapies called TNF inhibitors or TNF blockers reduces the risk of heart attack, says Dr. Lebwohl.
TNF-a (tumor necrosis factor-alpha) is a protein involved in inflammation. TNF inhibitors such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) “turn off” inflammation.
“Many registries show that when patients with rheumatoid arthritis [also an inflammatory disease] and psoriasis were treated with TNF blockers, they had a 50 percent reduction in heart attacks,” Lebwohl notes.
“Anything that treats psoriasis reduces inflammation,” Lebwohl says. “So far, the most data we have for reduction in heart attacks comes from the TNF blockers. The benefits to patients are clear skin and a reduction in comorbidities such as heart attack.”
A study comparing 12,732 people with psoriasis on biologics and 12,732 on oral psoriasis drugs, found that those on
biologics had a lower risk of cardiovascular diseases over a five-year follow-up period. People receiving TNF inhibitors, anti-interleukin-17, or anti-interleukin-23 drugs alone had a lower risk of heart disease.
There is also some evidence that sunlight, which can improve psoriasis, can have a positive impact on blood pressure, Gelfland notes. Some studies suggest that exposure to UV sunlight is associated with lower blood pressure.
To reduce heart attack risk in people with psoriasis, Dr. Kaffenberger makes sure her patients see a primary care doctor who can monitor their blood pressure and discuss other risk factors for heart disease.
“I also encourage patients to lose weight and quit smoking,” she says. Many psoriasis patients are overweight or obese, a key risk factor for metabolic syndrome.
If you have high blood pressure, your primary care doctor may recommend medication, lifestyle changes, or both.
The following tips can help to lower blood pressure naturally:
Get enough physical activity. Regular aerobic exercise can lower high blood pressure by about 5 to 8 mmHg. Aim for at least 30 minutes of moderate physical activity daily. In addition to aerobic exercise, try to include strength training at least two days a week.
Eat less salt. Read food labels to check for sodium content and limit your intake of processed foods, which often contain added sodium. For most adults, an ideal sodium limit is 1,500 milligrams (mg) a day; this may lower high blood pressure by about 5 to 6 mmHg.
Increase your potassium intake as part of a healthy diet. Potassium helps your body get rid of sodium. Bananas, leafy greens, avocados, and tomatoes are all good sources of the mineral.
In general, aim for 3,500 to 5,000 mg of potassium a day, which may lower blood pressure 4 to 5 mmHg. But your healthcare provider can recommend the right amount for you.
Don’t drink too much alcohol. To help manage blood pressure, it’s recommended that men limit their alcohol consumption to two drinks per day and women limit their intake to one drink per day.
If you don’t drink, there’s no health reason to start.
Reduce stress. Chronic stress may put you at risk for different chronic diseases, including high blood pressure, heart disease, and stroke. Finding ways to reduce or manage stress may help improve your overall health.
