Non-dipping nocturnal blood pressure in psoriasis vulgaris

Department of Cardiology, Faculty of Medicine, BezmiÂlem Foundation University, Vatan Street, 34093, Fatih/Istanbul, Turkey, .
Wiener klinische Wochenschrift (Impact Factor: 0.84). 11/2012; 124(23-24). DOI: 10.1007/s00508-012-0294-y
Source: PubMed


Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris.

Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10 % between the average day and night systolic BP.

Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0 mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5 mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1 %, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation.

Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.

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    • "Measuring BP with ABPM instead provides a BP profile throughout the whole 24-h period more accurately and can identify patients with MH or blunted BP reduction at night who are at greater risk for hypertension development, target organ damage, and cardiovascular morbidity and mortality [25]. Recently, we have reported that the non-dipping nocturnal BP pattern is more common in normotensive psoriatic patients compared to normal individuals [27]. Similar to results of the present study, half of the patients (51.0%) had non-dipper BP. "
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    ABSTRACT: Background Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. Material/Methods On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. Results The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. Conclusions MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable.
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    ABSTRACT: Psoriasis is a chronic systemic inflammatory disease characterized by topical skin lesions as well as an increased risk for cardiovascular disease (CVD). There is also increasing evidence that patients with psoriasis are more prone to several CVD risk factors (hypertension, obesity, dyslipidemia and smoking), non-cardiac vascular diseases (carotid, peripheral artery and chronic kidney disease) and metabolic co-morbidities (type 2 diabetes mellitus, metabolic syndrome, non-alcoholic fatty liver disease and obstructive sleep apnea) compared with the general population. The associations are even greater in patients with severe psoriasis and those with psoriatic arthritis. Insulin resistance, endothelial dysfunction and obesity induced by several adipokines and inflammatory cytokines are proposed as the common mechanisms linking psoriasis with CVD, vascular risk factors and metabolic diseases. The present narrative review considers the associations between psoriasis (and psoriatic arthritis) with CVD, vascular risk factors and metabolic diseases. Drugs that reduce CVD risk and improve metabolic parameters may also beneficially affect psoriasis severity and prognosis. Furthermore, anti-psoriatic drugs can exert different effects on CVD risk and metabolic co-morbidities. Therefore, physicians should be aware of these associations in order to adequately monitor and treat psoriatic patients.
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