“Psoriasis is linked with metabolic syndrome, and this is probably due to inflammation,” says Jessica Kaffenberger, MD, a dermatologist and director of medical student education at The Ohio State University Wexner Medical Center in Columbus. Metabolic syndrome is a cluster of symptoms that raise your risk for heart disease. High blood pressure is one of the five symptoms of metabolic syndrome, along with abdominal obesity, impaired glucose regulation, high triglycerides, and reduced HDL (“good”) cholesterol. Blood pressure measures the force of blood as it pushes against the artery walls. High blood pressure (140/90 mmHg or higher) is a significant risk factor for heart disease. A review of 24 studies published in the Journal of Hypertension in March 2013 that encompassed more than 300,000 psoriasis patients found high blood pressure more common in patients with severe psoriasis. In fact, more than half (54 percent) of the psoriasis patients had high blood pressure. Results from a patient database in the United Kingdom revealed that people with moderate or severe psoriasis were 20 and 48 percent, respectively, more likely to have uncontrolled high blood pressure. “When you have psoriasis, the inflammation causes many of the conditions [such as high blood pressure] that lead to heart attacks,” says Mark Lebwohl, MD, Sol and Clara Kest Professor of Dermatology and chair of the Kimberly and Eric J. Waldman department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “If you look at the frequency of heart attacks in patients with inflammation, it’s higher.” Research shows an association between psoriasis and an increase in several proteins and enzymes that indirectly raise blood pressure or increase inflammation. For example, angiotensin-converting enzyme (ACE) converts the hormone angiotensin I into angiotensin II, which indirectly raises blood pressure by causing blood vessels to constrict. Patients with psoriasis may have increased levels of angiotensins and angiotensin–converting ACE, leading to high blood pressure. Angiotensin II also stimulates the production of hormones that cause the kidneys to absorb salt and water, which in turn increases the amount of fluids in the body and raises blood pressure. Increased levels of the protein endothelin–1 in psoriasis patients has pro-inflammatory effects implicated in cardiovascular disease.
Reducing the Risks
Kaffenberger says she makes sure her psoriasis patients have a regular primary care doctor who can monitor their blood pressure. “I also encourage patients to lose weight and quit smoking,” she says. Many psoriasis patients are also overweight or obese, a key symptom of metabolic syndrome. Fat tissue also seems to be a source of angiotensin, so decreasing body weight may help lower blood pressure. Some biologic drugs may significantly reduce the risk of heart attack in psoriasis patients. A class of biological therapies called TNF inhibitors, which are used to treat people with psoriasis and other psoriatic disease, reduce the risk of heart attack, says Dr. Lebwohl. TNF-a (tumor necrosis factor-alpha) is a protein involved in inflammation. TNF inhibitors, such as Humira, Enbrel, and Remicade, turn off inflammation. “Many registries show that when patients with rheumatoid arthritis [also an inflammatory disease] and psoriasis were treated with TNF blockers, they had a 50 percent reduction in heart attacks,” he notes. Managing inflammatory skin disease and traditional cardiovascular risk factors is important. “Anything that treats psoriasis reduces inflammation,” Lebwohl says. “TNF blockers reduce heart attack risk the most. The benefits to patients are clear skin and a reduction in comorbidities such as heart attack.”
How to Lower Blood Pressure
In addition to eating a healthy diet, losing weight, and getting regular exercise, you can help lower your blood pressure by reducing your salt intake. Here are a few salt-reduction tips from the National Psoriasis Foundation:
Choose fresh or frozen vegetables, which are generally salt-free or low-salt.Choose low- or salt-free options in canned or prepared foods, or rinse foods (such as canned beans).Limit salted or cured meats.Go light on condiments, which are often hidden sources of salt.Use herbs and spices, instead of salt, to flavor food.
