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Balancing the Cardiovascular Risk and Dermatologic Hazard in Patients With Hypertension

Balancing the Cardiovascular Risk and Dermatologic Hazard in Patients With Hypertension To the Editor We greatly appreciated the article by Wu et al,1 which showed the independent association between long-term hypertension, long-term administration of β-blockers, and incident psoriasis in a large prospective cohort. However, although the study presented new evidence of the association, no management advice was proposed. How should patients with hypertension, who have the propensity to have psoriasis, be treated? Psoriasis most often arises in people younger than 40 years.2 Hypertension in young patients is characterized by sympathetic activation; thus, β-blockers provide satisfactory clinical effect in these patients.3 To avoid psoriasis, should β-blockers not be used in these patients? What is the risk of poor blood pressure control and progressive target organ damage for young patients treated with other antihypertensive agents? Administration of other antihypertensive agents may benefit young patients, while not all patients prescribed β-blockers would get psoriasis. In clinical practice, it is difficult to identify patients with future risk of psoriasis. With respect to the elderly patients with hypertension, many have other cardiovascular diseases, which are strong indications for β-blocker treatment.4 When deciding whether to prescribe β-blockers, how should we balance their risk of psoriasis, which impairs quality of life, with their benefit of reduced cardiovascular death? Further issues should be considered regarding the analysis of the independent effect of β-blockers on incident psoriasis. It seems that the authors conducted a thorough analysis,1 but the influence of concomitant antihypertensive drugs was not considered. Angiotensin-converting enzyme inhibitors, albeit with no independent association with psoriasis development in the study of Wu et al,1 might have a superimposed effect on β-blockers.5 As the participants in the study were older women with a median hypertension duration of 11 years, drug combinations would not be unusual. To validate the association, additional analyses adjusted for concurrent treatment with cardiovascular drugs are necessary. In conclusion, clinical physicians both in cardiology and dermatology should balance the cardiovascular risk and hazard of incident psoriasis in patients with hypertension. The use of β-blockers should not be completely discounted by the dermatologic community. Back to top Article Information Corresponding Author: Mao Chen, MD, PhD, Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue St, Chengdu 610041, Sichuan, China (hmaochen@vip.sina.com). Published Online: September 17, 2014. doi:10.1001/jamadermatol.2014.2551. Conflict of Interest Disclosures: None reported. References 1. Wu S, Han J, Li WQ, Qureshi AA. Hypertension, antihypertensive medication use, and risk of psoriasis [published online July 2, 2014]. JAMA Dermatol. 2014.PubMedGoogle Scholar 2. Basko-Plluska JL, Petronic-Rosic V. Psoriasis: epidemiology, natural history, and differential diagnosis. Psoriasis Targets Ther. 2012;2:67-76. http://www.dovepress.com/getfile.php?fileID=13920. Accessed July 29, 2014. 3. Brook RD, Julius S. Autonomic imbalance, hypertension, and cardiovascular risk. Am J Hypertens. 2000;13(6, pt 2):112S-122S.PubMedGoogle ScholarCrossref 4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-2219.PubMedGoogle ScholarCrossref 5. Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol. 2010;49(12):1351-1361.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Balancing the Cardiovascular Risk and Dermatologic Hazard in Patients With Hypertension

JAMA Dermatology , Volume 150 (12) – Dec 1, 2014

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Publisher
American Medical Association
Copyright
Copyright © 2014 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2014.2551
pmid
25229797
Publisher site
See Article on Publisher Site

Abstract

To the Editor We greatly appreciated the article by Wu et al,1 which showed the independent association between long-term hypertension, long-term administration of β-blockers, and incident psoriasis in a large prospective cohort. However, although the study presented new evidence of the association, no management advice was proposed. How should patients with hypertension, who have the propensity to have psoriasis, be treated? Psoriasis most often arises in people younger than 40 years.2 Hypertension in young patients is characterized by sympathetic activation; thus, β-blockers provide satisfactory clinical effect in these patients.3 To avoid psoriasis, should β-blockers not be used in these patients? What is the risk of poor blood pressure control and progressive target organ damage for young patients treated with other antihypertensive agents? Administration of other antihypertensive agents may benefit young patients, while not all patients prescribed β-blockers would get psoriasis. In clinical practice, it is difficult to identify patients with future risk of psoriasis. With respect to the elderly patients with hypertension, many have other cardiovascular diseases, which are strong indications for β-blocker treatment.4 When deciding whether to prescribe β-blockers, how should we balance their risk of psoriasis, which impairs quality of life, with their benefit of reduced cardiovascular death? Further issues should be considered regarding the analysis of the independent effect of β-blockers on incident psoriasis. It seems that the authors conducted a thorough analysis,1 but the influence of concomitant antihypertensive drugs was not considered. Angiotensin-converting enzyme inhibitors, albeit with no independent association with psoriasis development in the study of Wu et al,1 might have a superimposed effect on β-blockers.5 As the participants in the study were older women with a median hypertension duration of 11 years, drug combinations would not be unusual. To validate the association, additional analyses adjusted for concurrent treatment with cardiovascular drugs are necessary. In conclusion, clinical physicians both in cardiology and dermatology should balance the cardiovascular risk and hazard of incident psoriasis in patients with hypertension. The use of β-blockers should not be completely discounted by the dermatologic community. Back to top Article Information Corresponding Author: Mao Chen, MD, PhD, Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue St, Chengdu 610041, Sichuan, China (hmaochen@vip.sina.com). Published Online: September 17, 2014. doi:10.1001/jamadermatol.2014.2551. Conflict of Interest Disclosures: None reported. References 1. Wu S, Han J, Li WQ, Qureshi AA. Hypertension, antihypertensive medication use, and risk of psoriasis [published online July 2, 2014]. JAMA Dermatol. 2014.PubMedGoogle Scholar 2. Basko-Plluska JL, Petronic-Rosic V. Psoriasis: epidemiology, natural history, and differential diagnosis. Psoriasis Targets Ther. 2012;2:67-76. http://www.dovepress.com/getfile.php?fileID=13920. Accessed July 29, 2014. 3. Brook RD, Julius S. Autonomic imbalance, hypertension, and cardiovascular risk. Am J Hypertens. 2000;13(6, pt 2):112S-122S.PubMedGoogle ScholarCrossref 4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-2219.PubMedGoogle ScholarCrossref 5. Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol. 2010;49(12):1351-1361.PubMedGoogle ScholarCrossref

Journal

JAMA DermatologyAmerican Medical Association

Published: Dec 1, 2014

References