Risks of hypertension associated with cyclosporine, nonsteroidal anti-inflammatory drugs, and systemic glucocorticoids in patients with psoriasis: a nationwide population-based nested case–control study in Taiwan

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Abstract

Purpose

Patients with psoriasis and/or psoriatic arthritis (PsA) are known to have increased cardiovascular morbidity and mortality. Hypertension, an important risk factor for cardiovascular disease, is highly prevalent in patients with psoriasis and/or PsA. The effects of anti-psoriatic medications – including cyclosporine, nonsteroidal anti-inflammatory drugs, and glucocorticoids – on hypertension remain unclear. We examined whether such medication exposure was associated with hypertension in psoriasis patients.

Methods

This population-based, nested case–control study analyzed data from an inception psoriasis cohort identified from Taiwan's National Health Insurance Research Database, 2000–2010. A total of 1530 patients with newly diagnosed hypertension and 4542 age- and gender-matched controls were included in the analysis. Conditional logistic regressions were applied to estimate the effects of drug of interest on hypertension.

Results

After adjusting for potential confounders, patients with current use of cyclosporine [odds ratio (OR) = 7.13; 95% confidence interval (CI) 1.85–27.49], nonsteroidal anti-inflammatory drugs (OR = 2.2; 95% CI 1.95–2.49), or systemic glucocorticoids (OR = 1.42; 95% CI 1.23–1.64) showed an increased risk of hypertension as compared to those not exposed to these drugs. Moreover, an increasing dose or combined use of nonsteroidal anti-inflammatory drugs and glucocorticoids was associated with increased hypertension risk. The risk of hypertension associated with glucocorticoids, or combined use was greatest among patients aged 49 years or less.

Conclusions

The use of cyclosporine, nonsteroidal anti-inflammatory drugs, or glucocorticoid was associated with hypertension in patients with psoriasis and/or PsA. These study results inform physicians on the importance of early identification of hypertension during therapy with such medication. Copyright © 2015 John Wiley & Sons, Ltd.

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