Link Between Psoriasis And Hypertension

Psoriasis, a chronic inflammatory disease that affects approximately 2-4% of the population has been linked to other serious conditions affecting not only the skin, but other organs and systems in the body. Clinically, psoriasis presents itself as red plaques or patches on the skin with silver or white scales. These skin lesions can occur anywhere on the body and can be itchy or painful. The redness is due to the dilation of blood vessels and the scales are caused by layers of rapidly turned over skin cells. The pathophysiology of psoriasis is a complex process that involves the immune system and skin cells. Researchers have been unable to identify a singular cause for psoriasis, but studies suggest that there are multiple genetic factors that affect the cells of the immune system that subsequently adversely affect the skin. Approximately one third of people with a family history of psoriasis will develop this condition, and there is an increased incidence in both identical and fraternal twins.

Psoriasis symptoms are caused by dysregulation of immune system

Dysregulation of the immune system has an adverse effect on the function of the cells in the immune system. One type of cell that is affected is the T-cell.

Typically, new skin cells take weeks to renew, but in the case of psoriasis, this process takes just days. This causes the build-up of dead skin cells that, in turns, results in the development of the scale.

Other factors affected by the dysregulation of the immune system include the cytokines. One cytokine in particular, called tumor necrosis factor (TNF) has been studied extensively. TNF has been found to play a significant role in the pathophysiology of psoriasis and, as a result, medications have been developed to treat psoriasis that specifically target the TNF.

Genetic factors are linked to the development of psoriasis

See Also: The Ten Most Common Psoriasis Triggers

They have determined that for a person to develop psoriasis there needs to be a combination of the genes and exposure to one or more external triggers. These include stress, some types of medications, infection, and skin injury.  Finding the genes responsible has been challenging. Studies of the pathogenesis of psoriasis continue to find new genetic links and mutations that may cause this skin disease. There has been a recent development made by a group of researchers from the Washington University School of Medicine in St. Louis, who have studied the gene CARD14. This gene is directly linked to the plaque psoriasis, the most common form of psoriasis affecting 80% of people with this disease. CARD14 is a gene that encodes a protein that links with other proteins forming molecular scaffold for assembly of various cellular multi-protein complexes. This study has found that CARD14 mutations may also play a role in other forms of psoriasis. This discovery and others like it could lead to more targeted therapies for this disease.

Psoriasis Affects Multiple Organs And Is Linked To Hypertension

Psoriasis is a disease that is more than just “skin deep”.

The association between chronic inflammation and cardiovascular disease has been proven and is widely accepted by the medical community. This may be the underlying link between psoriasis and cardiovascular disease. The inflammatory process of psoriasis is caused by the activation and increase of the number of cells in the immune system that cause the inflammation. These cells circulate throughout the body causing widespread inflammation which sets the stage for the development of risk factors for cardiovascular disease. The inflammation in turn causes the psoriatic lesions to enlarge perpetuating the inflammatory cycle. 

Chronic inflammation mediates the effect of psoriasis on blood pressure

One consequence of the chronic inflammation that leads to hypertension and cardiovascular disease in people with psoriasis is the impairment of the lining of the blood vessels, called the endothelium. Impaired endothelial function is related to an imbalance of factors that affect the ability of the blood vessels to maintain a normal blood pressure. This imbalance can lead to hypertension. Another possible cause of hypertension in patients with psoriasis relates to an enzyme called angiotensin-converting enzyme, or ACE. ACE is a substance in the body that contributes to the constriction of the blood vessels and it causes the release of hormones that can also raise the blood pressure. People with psoriasis have much higher levels of ACE than those without and this may in part explain why people with psoriasis have a higher incidence of hypertension.

The cause for this is not yet known. It has been shown that the more severe the psoriasis, the higher the risk for developing the hypertension. There seems to be a correlation between the size and number of skin lesions and the level of inflammation. The greater number and size of the lesions results in more severe levels of inflammation which in turn leads to an increased risk for developing the hypertension.  

Management options are under development

Some studies have given evidences suggesting that there is a decrease in the incidence of cardiovascular disease with the long-term treatment of psoriasis using methotrexate, a commonly used drug for arthritis and other rheumatic conditions. Another medication, etanercept, has been shown to reduce the level of one of the biomarkers for cardiovascular disease in the blood which may mean a lower overall cardiovascular risk. More research still needed in this area.

See Also: Natural Treatments for Psoriasis

Multifaceted nature of psoriasis requires coordinated approach to the treatment and management

Patients with psoriasis require more than just the treatment of their skin symptoms. They have a higher incidence of cardiovascular disease with hypertension, diabetes, and metabolic syndrome.  These patients need to be evaluated by their healthcare providers and screened for cardiovascular risk factors. Management of risk factors for cardiovascular disease, including hypertension, in conjunction with the treatment for psoriasis that results in the reduction of the systemic inflammation, lowers the risk of heart attack, stroke and diabetes and can improve the person’s quality of life.