The association between psoriasis and hypertension: a systematic reviewandmeta-analysis of observational studies

Population-based observational studies have suggested a relationship between psoriasis and hypertension. We performed a systematic review and meta-analysis to better understand the association between psoriasis and hypertension. We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register from 1 January 1980 to 1 January 2012. Two authors independently assessed trial eligibility and quality. We applied the Meta-Analysis of Observational Studies in Epidemiology guidelines in the conduct of this study. We identified 24 observational studies with a total of approximately 2.7 million study participants fulfilling our inclusion criteria. Among them, 309 469 were patients with psoriasis. On the basis of random effects modeling of case-control and cross-sectional studies, the odds ratio (OR) for hypertension among patients with psoriasis was 1.58 [95% confidence interval (CI) 1.42-1.76] compared with the controls. The OR for hypertension among patients with mild psoriasis was 1.30 (95% CI 1.15-1.47) and the OR for hypertension among patients with severe psoriasis was 1.49 (95% CI 1.20-1.86) compared with the controls. Two cohort studies examining incidence of hypertension found that psoriasis was associated with a hazard ratio of 1.09 (95% CI 1.05-1.14) and 1.17 (95% CI 1.06-1.30) for development of hypertension. In a subgroup analysis, patients with psoriatic arthritis also had an increased prevalence of hypertension (OR 2.07, 95% CI 1.41-3.04). Psoriasis and psoriatic arthritis are associated with greater prevalence of hypertension. Patients with severe psoriasis have greater odds of hypertension than those with mild psoriasis.