Psoriasis is a chronic skin disease characterized by recurrent inflammation, and is increasingly being recognized as a systemic inflammatory disorder, which is associated with cardiovascular events, metabolic syndrome, diabetes, obesity and hypertension. Recent findings have suggested a greater risk of hypertension, particularly difficult-to-control hypertension, in patients with severe psoriasis. Additionally, abnormal activation of immune cells with overexpression of pathogenic cytokines in psoriasis, leading to immune cascade, oxidative injury and collagen deposition in arteries, may further contribute to vascular stiffening and hypertension. However, studies have demonstrated beneficial effects of antipsoriatic drugs on blood pressure and the cardiovascular system, including immunosuppressants and biological reagents targeting tumour necrosis factor-α, interleukin (IL)-17A and the IL-12/23 p40 subunit. This review summarizes the mechanisms underlying the impact of systemic inflammation on skin and arteries, and assesses the epidemiological and clinical links between psoriasis and hypertension.
© 2020 British Association of Dermatologists.