Hypertension, Antihypertensive Medication Use, and Risk of Psoriasis

IMPORTANCE Individuals with psoriasis have an elevated risk of hypertension, and antihypertensive medications, especially beta-blockers, have been linked to psoriasis development. However, the association of prior existing hypertension and antihypertensive medications with risk of incident psoriasis has not been assessed using prospective data. OBJECTIVE To evaluate the association of hypertension and antihypertensive medications with risk of psoriasis. DESIGN, SETTING, AND PARTICIPANTS We performed a prospective cohort study (June 1, 1996, to June 1, 2008) of 77 728 US women from the Nurses' Health Study who provided biennially updated data on hypertension and antihypertensive medications. MAIN OUTCOMES AND MEASURES Physician-diagnosed psoriasis. RESULTS A total of 843 incident psoriasis cases were documented during 1 066 339 person-years of follow-up. Compared with normotensive women, women with a hypertension duration of 6 years or more were at a higher risk of developing psoriasis (hazard ratio [HR], 1.27; 95% CI, 1.03-1.57). In stratified analysis, the risk of psoriasis was higher among hypertensive women without medication use (HR, 1.49; 95% CI, 1.15-1.92) and among hypertensive women with current medication use (HR, 1.31; 95% CI, 1.10-1.55) when compared with normotensive participants without medication use. Compared with women who never used beta-blockers, the multivariate HRs for psoriasis for women who regularly used beta-blockers were 1.11 (95% CI, 0.82-1.51) for 1 to 2 years of use, 1.06 (95% CI, 0.79-1.40) for 3 to 5 years of use, and 1.39 (95% CI, 1.11-1.73) for 6 years or more of use (P for trend = .009). No association was found between use of other individual antihypertensive drugs and risk of psoriasis. CONCLUSIONS AND RELEVANCE Long-term hypertensive status is associated with an increased risk of psoriasis. Long-term regular use of beta-blockers may also increase the risk of psoriasis.