The Surprising Link Between Psoriasis and High Blood Pressure

Psoriasis, an inflammatory disease that causes scaly lesions on the skin, is associated with a host of other chronic health conditions, most notably psoriatic arthritis.

But there’s a medical problem related to psoriasis that may go overlooked: hypertension, or high blood pressure.

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.

People With Psoriasis Skin Symptoms Are More Likely to Have High Blood Pressure

“Patients with psoriasis typically have a higher rate of high blood pressure compared to the general population,” says Joel Gelfand, MD, vice chair of clinical research and medical director in the dermatology clinical studies unit at Penn Medicine in Philadelphia.

A research review in the Journal of Hypertension that analyzed medical records of more than 300,000 people with psoriasis found high blood pressure to be particularly common in patients with severe skin symptoms, affecting more than half (54 percent).

There is also evidence that people with moderate or severe psoriasis skin symptoms are more likely to have uncontrolled blood pressure, as per a study published in JAMA Dermatology. “It is known that as the body surface area of psoriasis increases, the likelihood of achieving adequate blood pressure control among people with hypertension goes down,” says Dr. Gelfand.

The Link Between Psoriasis and High Blood Pressure: Inflammation

The connection between psoriasis and high blood pressure is complex and not fully understood. “It is not known if psoriasis itself causes hypertension or if the relationship is caused by other risk factors such as obesity, smoking, or diet,” says Gelfand.

Patients with psoriasis appear to be especially prone to other risk factors for high blood pressure such as insulin resistance and diabetes, he says.

Psoriasis is also linked with metabolic syndrome, “and this is probably due to inflammation,” says Jessica Kaffenberger, MD, division director of medical dermatology at The Ohio State University Wexner Medical Center in Columbus.

Metabolic syndrome is a cluster of symptoms that raise heart disease risk. 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.

“When you have psoriasis, the inflammation causes or is associated with many of the conditions [such as high blood pressure] that lead to heart attacks,” says Mark Lebwohl, MD, professor of dermatology and dean for clinical therapeutics 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.”

Looking at the Psoriasis-Hypertension Link on the Molecular Level

Research, including a study in Medical Archives, shows an association between psoriasis and an increase in several enzymes and proteins that indirectly raise blood pressure or increase inflammation.

Angiotensin-converting enzyme (ACE) converts the hormone angiotensin I into angiotensin II, causing blood vessels to constrict and thus raising blood pressure. Patients with psoriasis may have increased levels of both angiotensins and ACE.

Angiotensin II also stimulates the production of hormones that cause the kidneys to absorb salt and water, which raises blood pressure by increasing the amount of fluids in the body.

Psoriasis patients may also have increased levels of the protein endothelin-1, which has pro-inflammatory effects implicated in cardiovascular disease.

Some Psoriasis Therapies May Help Reduce Hypertension and Heart Attack Risk

There is now evidence that treating psoriasis improves hypertension and reduces heart attack risk.

Some biologic drugs for psoriasis may significantly reduce the risk of heart attack. A class of biological therapies called TNF inhibitors or TNF blockers reduces the risk of heart attack, says Dr. Lebwohl.

TNF-a (tumor necrosis factor-alpha) is a protein involved in inflammation. TNF inhibitors such as adalimumab (Humira), etanercept (Enbrel), and infliximab (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,” Lebwohl notes.

“Anything that treats psoriasis reduces inflammation,” Lebwohl says. “So far, the most data we have for reduction in heart attacks comes from the TNF blockers. The benefits to patients are clear skin and a reduction in comorbidities such as heart attack.”

There is also some evidence that sunlight, which improves psoriasis, can have a positive impact on blood pressure, Gelfland notes. A study published in February 2020 in the Journal of the American Heart Association suggests that exposure to UV sunlight is associated with lower systolic blood pressure.

Lifestyle Changes Can Help Lower Blood Pressure and Reduce Heart Attack Risk

To reduce heart attack risk in people with psoriasis, Dr. Kaffenberger makes sure her patients see a primary care doctor who can monitor their blood pressure and discuss other risk factors for heart disease.

“I also encourage patients to lose weight and quit smoking,” she says. Many psoriasis patients are overweight or obese, a key risk factor for metabolic syndrome. Fat tissue seems to be a source of angiotensin, so decreasing body weight may help lower blood pressure.

If you have high blood pressure your primary care doctor may recommend medication, lifestyle changes, or both. Penn Medicine offers the following tips to lower blood pressure naturally:

Get enough physical activity. Try to get the recommended amount of physical activity. The Office of Disease Prevention and Health Promotion (OASH) recommends at least 150 minutes a week of moderate-intensity physical activity.

Eat less salt. Read food labels to check for sodium content and try to limit your intake of processed foods.

Increase your potassium intake. Potassium helps your body get rid of sodium. Bananas, melons, oranges, avocados, and tomatoes are all good sources of the mineral.

Don’t drink too much alcohol. To help manage blood pressure, it’s recommended that men limit their alcohol consumption to two drinks per day and women limit their intake to one drink per day, according to the American Heart Association. If you don’t drink, there’s no health reason to start, per OASH.

Reduce stress. Chronic stress may put you at risk for different chronic diseases, including high blood pressure, heart disease, and stroke. Finding ways to reduce or manage stress may help improve your overall health.

New Initiative Aims to Help Improve Hypertension Awareness and Treatment

Patients with psoriasis tend to be underdiagnosed and undertreated for cardiovascular risk factors such as high blood pressure and high cholesterol. “We are trying to improve this problem through the development and testing of a centralized care coordinator model supported by the National Psoriasis Foundation,” Gelfland says.

In the new model, described in an original investigation published in January 2022 in JAMA Dermatology, people with psoriasis who have early heart disease risk factors would be referred by their dermatologist or rheumatologist to a care coordinator to help manage risk factors and connect them with a primary care provider.