Patients with Both Psoriasis, Hypertension Have Increased Mortality Likelihood

A new study found individuals with both psoriasis and hypertension have a 2-fold increase in all-cause mortality risk.¹

“Our objective was to unravel the intricate connections among psoriasis, hypertension, and mortality through a meticulous analysis of data derived from the NHANES spanning the periods 2003–2006 and 2009–2014,” wrote investigators, led by Honglei Zhao, from the department of dermatology at Beilun District People’s Hospital in China. “This study marks a pioneering effort, representing the first exploration into the collective impact of psoriasis and hypertension on mortality.”

Previous observational studies discovered a link between psoriasis and hypertension, yet not much was discovered on the combined effects of psoriasis and hypertension on all-cause mortality.2 Hence investigators conducted a prospective cohort study to examine the synergistic impact of psoriasis and hypertension on mortality among US adults.1

Investigators leveraged data from the National Health and Nutrition Examination Study spanning 2 periods: 2003 – 2006 and 2009 – 2014. A psoriasis diagnosis was self-reported, and a hypertension diagnosis was confirmed by specific parameters such as a systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, a physician-reported diagnosis, or the use of antihypertensive medication. Continuous monitoring of participants’ vital status persisted until December 31, 2019.

The study included 19,799 participants; 554 had psoriasis (2.798%) and 7692 (38.85%) had hypertension. Also, among participants with hypertension, 276 had a historical record of psoriasis.

The sample (mean age: 45 years) had 49.91% males and 69.01% identifying as non-Hispanic white. Individuals with both hypertension and psoriasis had a greater likelihood of being female, non-Hispanic white, and former smokers. Those with only psoriasis had a greater likelihood of being non-Hispanic white and former smokers.

Investigators used multivariable logistic regression analyses to assess the mortality outcome of the combined efforts of psoriasis and hypertension. The analyses revealed patients with psoriasis had an increased risk of hypertension, compared with those without psoriasis.

During a medium follow-up period of approximately 8 years (105 months), 1845 participants faced all-cause mortality. Participants with both psoriasis and hypertension had an approximate 2-fold increase in all-cause mortality risk (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.60 – 3.40), which was a greater risk than patients with just psoriasis (HR, 0.73; 95% CI, 0.35 – 1.53) or hypertension (HR, 1.78; 95% CI, 1.55 – 2.04).

“It is crucial to emphasize that the existence of psoriasis can serve as a substantial supplementary risk factor for all-cause mortality in the context of hypertension,” investigators wrote. “These results bear significant implications, underscoring the potential critical role of screening for psoriasis in augmenting the life expectancy of individuals with hypertension.”

A stratified analysis distinguishing between the presence with and without psoriasis saw hypertension correlated with an increased risk of all-cause mortality in individuals without psoriasis (HR, 1.77; 95% CI, 1.54 – 2.04). Additionally, this correlation was also seen among individuals with psoriasis (HR, 3.23; 95% CI, 1.47 – 7.13).

“Our findings illuminate a substantial elevation in the risk of all-cause mortality among individuals simultaneously grappling with psoriasis and hypertension, a phenomenon that persists even following rigorous adjustments for demographic factors (sex, age, race, education, marital status), BMI category, smoking status, drinking status, and diabetes,” investigators wrote. “These results not only underscore the exigency of targeted psoriasis screening within the hypertensive demographic but also lay a robust foundation for further exploration in both foundational and clinical research.”

References

1. ^{Zhao H, Wu J, Wu Q. Synergistic impact of psoriasis and hypertension on all-cause mortality risk: A prospective cohort study. PLoS One. 2024;19(7):e0306048. Published 2024 Jul 5. doi:10.1371/journal.pone.0306048}
2. ^{Duan X, Liu J, Mu Y, et al. A systematic review and meta-analysis of the association between psoriasis and hypertension with adjustment for covariates. Medicine (Baltimore). 2020;99(9):e19303. doi:10.1097/MD.0000000000019303}