title: Psoriasis and hypertension severity: results from a case-control study.
abstract: BACKGROUND
  Epidemiologic studies have provided new insights into the association between psoriasis and cardiovascular diseases. Previous population studies have examined hypertension frequency in psoriasis patients. However, the relationship between severity of hypertension and psoriasis has not been characterized.
  
  
  OBJECTIVE
  We sought to investigate whether patients with psoriasis have more difficult-to-manage hypertension compared to non-psoriatic hypertensive patients.
  
  
  METHODS
  We performed a case-control study using the University of California Davis electronic medical records. The cases were defined as patients diagnosed with both psoriasis and hypertension, and controls were defined as patients with hypertension and without psoriasis. In this identified population, 835 cases were matched on age, sex, and body mass index (BMI) to 2418 control patients.
  
  
  RESULTS
  Treatment with multiple anti-hypertensives was significantly associated with the presence of psoriasis using univariate (p < 0.0001) and multivariable analysis, after adjusting for diabetes, hyperlipidemia, and race (p < 0.0001). Compared to hypertensive patients without psoriasis, psoriasis patients with hypertension were 5 times more likely to be on a monotherapy antihypertensive regimen (95% CI 3.607.05), 9.5 times more likely to be on dual antihypertensive therapy (95% CI 6.68-13.65), 16.5 times more likely to be on triple antihypertensive regimen (95% CI 11.01-24.84), and 19.9 times more likely to be on quadruple therapy or centrally-acting agent (95% CI 10.58-37.33) in multivariable analysis after adjusting for traditional cardiac risk factors.
  
  
  CONCLUSIONS
  Psoriasis patients appear to have more difficult-to-control hypertension compared to non-psoriatic, hypertensive patients.
authors.affiliation: Department of Dermatology, University of California Davis, Sacramento, California, United States of America. aprilarmstrong@post.harvard.edu
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lin
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Chambers
authors.forename: Mary E
authors.initials: ME
authors.lastname: Sockolov
authors.forename: David L
authors.initials: DL
authors.lastname: Chin
mesh_terms: D016022:Case-Control Studies; D003710:Demography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011565:Psoriasis / Q000150:complications*; D012720:Severity of Illness Index