Takeshita Junko, Wang Shuwei, Shin Daniel B, Mehta Nehal N, Kimmel Stephen E, Margolis David J, Troxel Andrea B, Gelfand Joel M
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Division of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
JAMA Dermatol. 2015 Feb;151(2):161-9. doi: 10.1001/jamadermatol.2014.2094.
Hypertension is prevalent among patients with psoriasis. The effect of psoriasis and its severity on hypertension control is unknown.
To determine the association between uncontrolled blood pressure and psoriasis, both overall and according to objectively measured psoriasis severity, among patients with diagnosed hypertension.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study nested in a prospective cohort drawn from The Health Improvement Network (THIN), an electronic medical records database broadly representative of the general population in the United Kingdom. The study population included a random sample of patients with psoriasis (n = 1322) between the ages of 25 and 64 years in THIN who were included in the Incident Health Outcomes and Psoriasis Events prospective cohort and their age- and practice-matched controls without psoriasis (n = 11,977). All included patients had a diagnosis of hypertension; their psoriasis diagnosis was confirmed and disease severity was classified by their general practitioners.
Uncontrolled hypertension was defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher based on the blood pressure recorded closest in time to the assessment of psoriasis severity.
There was a significant positive dose-response relationship between uncontrolled hypertension and psoriasis severity as objectively determined by the affected body surface area in both unadjusted and adjusted analyses that controlled for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs (adjusted odds ratio [aOR], 0.97; 95% CI, 0.82-1.14 for mild psoriasis; aOR, 1.20; 95% CI, 0.99-1.45 for moderate psoriasis; and aOR, 1.48; 95% CI, 1.08-2.04 for severe psoriasis; P = .01 for trend). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, although not statistically significantly so (aOR, 1.10; 95% CI, 0.98-1.24).
Among patients with hypertension, psoriasis was associated with a greater likelihood of uncontrolled hypertension in a dose-dependent manner, with the greatest likelihood observed among those with moderate to severe psoriasis defined by 3% or more of the body surface area affected. Our data suggest a need for more effective blood pressure management, particularly among patients with more severe psoriasis.
高血压在银屑病患者中很常见。银屑病及其严重程度对高血压控制的影响尚不清楚。
确定确诊为高血压的患者中，未控制的血压与银屑病之间的总体关联，以及根据客观测量的银屑病严重程度确定的关联。
设计、设置和参与者：基于人群的横断面研究，嵌套于从健康改善网络（THIN）抽取的前瞻性队列中，THIN是一个广泛代表英国普通人群的电子病历数据库。研究人群包括THIN中年龄在25至64岁之间的银屑病患者随机样本（n = 1322），这些患者被纳入了健康结局与银屑病事件前瞻性队列，以及年龄和执业情况匹配的无银屑病对照（n = 11977）。所有纳入患者均诊断为高血压；其银屑病诊断得到确认，疾病严重程度由其全科医生分类。
根据最接近银屑病严重程度评估时记录的血压，未控制的高血压定义为收缩压140 mmHg或更高或舒张压90 mmHg或更高。
在未调整和调整分析中，未控制的高血压与银屑病严重程度之间存在显著的正剂量反应关系，调整分析控制了年龄、性别、体重指数、吸烟和饮酒状况、合并症的存在以及当前使用的抗高血压药物和非甾体抗炎药（轻度银屑病的调整优势比[aOR]为0.97；95%置信区间[CI]为0.82 - 1.14；中度银屑病的aOR为1.20；95% CI为0.99 - 1.45；重度银屑病的aOR为1.48；95% CI为1.08 - 2.04；趋势P = 0.01）。总体而言，银屑病患者中未控制高血压的可能性也有所增加，尽管未达到统计学显著水平（aOR为1.10；95% CI为0.98 - 1,24）。
在高血压患者中，银屑病与未控制高血压的可能性呈剂量依赖性增加，在体表面积受累3%或更多定义的中度至重度银屑病患者中观察到的可能性最大。我们的数据表明需要更有效的血压管理，特别是在银屑病更严重的患者中。
