Lee Meng-Sui, Chang Chia-Hsuin, Lin Ruey-Yi, Lai Mei-Shu
Department of Dermatology, Taipei City Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):133-40. doi: 10.1002/pds.3890. Epub 2015 Nov 2.
Patients with psoriasis and/or psoriatic arthritis (PsA) are known to have increased cardiovascular morbidity and mortality. Hypertension, an important risk factor for cardiovascular disease, is highly prevalent in patients with psoriasis and/or PsA. The effects of anti-psoriatic medications - including cyclosporine, nonsteroidal anti-inflammatory drugs, and glucocorticoids - on hypertension remain unclear. We examined whether such medication exposure was associated with hypertension in psoriasis patients.
This population-based, nested case-control study analyzed data from an inception psoriasis cohort identified from Taiwan's National Health Insurance Research Database, 2000-2010. A total of 1530 patients with newly diagnosed hypertension and 4542 age- and gender-matched controls were included in the analysis. Conditional logistic regressions were applied to estimate the effects of drug of interest on hypertension.
After adjusting for potential confounders, patients with current use of cyclosporine [odds ratio (OR) = 7.13; 95% confidence interval (CI) 1.85-27.49], nonsteroidal anti-inflammatory drugs (OR = 2.2; 95% CI 1.95-2.49), or systemic glucocorticoids (OR = 1.42; 95% CI 1.23-1.64) showed an increased risk of hypertension as compared to those not exposed to these drugs. Moreover, an increasing dose or combined use of nonsteroidal anti-inflammatory drugs and glucocorticoids was associated with increased hypertension risk. The risk of hypertension associated with glucocorticoids, or combined use was greatest among patients aged 49 years or less.
The use of cyclosporine, nonsteroidal anti-inflammatory drugs, or glucocorticoid was associated with hypertension in patients with psoriasis and/or PsA. These study results inform physicians on the importance of early identification of hypertension during therapy with such medication.
已知银屑病和/或银屑病关节炎（PsA）患者的心血管发病率和死亡率会升高。高血压是心血管疾病的重要危险因素，在银屑病和/或PsA患者中非常普遍。包括环孢素、非甾体抗炎药和糖皮质激素在内的抗银屑病药物对高血压的影响尚不清楚。我们研究了此类药物暴露是否与银屑病患者的高血压有关。
这项基于人群的巢式病例对照研究分析了2000 - 2010年从台湾国民健康保险研究数据库中确定的初始银屑病队列的数据。分析共纳入1530例新诊断高血压患者和4542例年龄及性别匹配的对照。应用条件逻辑回归来估计感兴趣药物对高血压的影响。
在调整潜在混杂因素后，当前使用环孢素的患者[比值比（OR）= 7.13；95%置信区间（CI）1.85 - 27.49]、非甾体抗炎药（OR = 2.2；95% CI 1.95 - 2.49）或全身糖皮质激素（OR = 1.42；95% CI 1.23 - 1.64）与未接触这些药物的患者相比，高血压风险增加。此外，非甾体抗炎药和糖皮质激素剂量增加或联合使用与高血压风险增加有关。与糖皮质激素或联合使用相关的高血压风险在49岁及以下患者中最高。
环孢素、非甾体抗炎药或糖皮质激素的使用与银屑病和/或PsA患者的高血压有关。这些研究结果告知医生在使用此类药物治疗期间早期识别高血压的重要性。
