Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom.
Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom.
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DOI：
10.1001/jamadermatol.2014.2094
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发表时间：
2015-02
期刊：
影响因子：
10.9
通讯作者：
Gelfand JM
中科院分区：
文献类型：
--
作者：
Takeshita J;Wang S;Shin DB;Mehta NN;Kimmel SE;Margolis DJ;Troxel AB;Gelfand JM
牛皮癣的症状有哪些？银屑病及其严重程度对高血压控制的影响尚不清楚。在诊断为高血压的患者中，确定血压不受控制与银屑病之间的关系，包括总体和客观测量的银屑病严重程度。基于人群的横断面研究嵌套在一个前瞻性队列中，该队列来自健康改善网络（THIN），一个广泛代表英国普通人群的电子病历数据库。研究人群包括THIN中年龄在25 - 64岁之间的银屑病患者（n = 1322）的随机样本，这些患者被纳入事件健康结局和银屑病事件前瞻性队列，以及他们的年龄和实践匹配的无银屑病对照组（n = 11 977）。所有纳入的患者均诊断为高血压;他们的银屑病诊断得到证实，疾病严重程度由他们的全科医生进行分类。未控制的高血压定义为收缩压140 mm Hg或更高或舒张压90 mm Hg或更高，基于最接近银屑病严重程度评估的时间记录的血压。在未校正和校正的分析中，未控制的高血压和银屑病严重程度之间存在显著的正剂量反应关系，这些分析是通过受影响的体表面积客观确定的，这些分析控制了年龄、性别、体重指数、吸烟和饮酒状况、合并症的存在以及目前使用的降压药物和非甾体抗炎药（轻度银屑病的校正比值比[aOR]为0.97; 95%CI为0.82-1.14;中度银屑病的aOR为1.20; 95%CI为0.99-1.45;重度银屑病的aOR为1.48; 95%CI为1.08-2.04;趋势P = 0.01）。总体而言，银屑病患者高血压不受控制的可能性也增加了，尽管没有统计学显著性（aOR，1.10; 95% CI，0.98-1.24）。在高血压患者中，银屑病与不受控制的高血压的可能性更大，呈剂量依赖性，在受影响体表面积≥ 3%的中重度银屑病患者中观察到的可能性最大。我们的数据表明需要更有效的血压管理，特别是在更严重的银屑病患者中。
Hypertension is prevalent among patients with psoriasis. The effect of psoriasis and its severity on hypertension control is unknown. To determine the association between uncontrolled blood pressure and psoriasis, both overall and according to objectively measured psoriasis severity, among patients with diagnosed hypertension. Population-based cross-sectional study nested in a prospective cohort drawn from The Health Improvement Network (THIN), an electronic medical records database broadly representative of the general population in the United Kingdom. The study population included a random sample of patients with psoriasis (n = 1322) between the ages of 25 and 64 years in THIN who were included in the Incident Health Outcomes and Psoriasis Events prospective cohort and their age- and practice-matched controls without psoriasis (n = 11 977). All included patients had a diagnosis of hypertension; their psoriasis diagnosis was confirmed and disease severity was classified by their general practitioners. Uncontrolled hypertension was defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher based on the blood pressure recorded closest in time to the assessment of psoriasis severity. There was a significant positive dose-response relationship between uncontrolled hypertension and psoriasis severity as objectively determined by the affected body surface area in both unadjusted and adjusted analyses that controlled for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs (adjusted odds ratio [aOR], 0.97; 95% CI, 0.82-1.14 for mild psoriasis; aOR, 1.20; 95% CI, 0.99-1.45 for moderate psoriasis; and aOR, 1.48; 95% CI, 1.08-2.04 for severe psoriasis; P = .01 for trend). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, although not statistically significantly so (aOR, 1.10; 95% CI, 0.98-1.24). Among patients with hypertension, psoriasis was associated with a greater likelihood of uncontrolled hypertension in a dose-dependent manner, with the greatest likelihood observed among those with moderate to severe psoriasis defined by 3% or more of the body surface area affected. Our data suggest a need for more effective blood pressure management, particularly among patients with more severe psoriasis.