Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint study

• Published in: Journal of hypertension Vol. 32; no. 3; p. 667
• Main Authors: Bang, Casper N, Okin, Peter M, Køber, Lars, Wachtell, Kristian, Gottlieb, Alice Bendix, Devereux, Richard B
• Format: Journal Article
• Language: English
• Published: England 01.03.2014
• Subjects: Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive Agents - therapeutic use; Atrial Fibrillation - etiology; Double-Blind Method; Female; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - drug therapy; Losartan - therapeutic use; Male; Middle Aged; Prospective Studies; Psoriasis - complications; Risk Factors; Treatment Outcome
• ISSN: 1473-5598
• DOI: 10.1097/HJH.0000000000000078

Inflammation contributes to the pathogenesis of psoriasis as well as atrial fibrillation. The impact of psoriasis and its association with new-onset atrial fibrillation was assessed in hypertensive patients with left ventricular hypertrophy (LVH). The predictive value of baseline or incident psoriasis for new-onset atrial fibrillation was evaluated in 7099 hypertensive patients with electrocardiographic LVH with no history of atrial fibrillation or other cardiovascular disease, in sinus rhythm on their baseline electrocardiogram. A total of 154 patients (2.2%) had or developed psoriasis and new-onset atrial fibrillation occurred in 506 patients (7.1%) during a mean follow-up of 4.7 ± 1.1 years. At baseline, the psoriasis patients were younger (65 ± 7 vs. 67 ± 7 years) and had less left ventricle hypertrophy by ECG Sokolow-Lyon voltage (27.6 ± 9.7 vs. 30.1 ± 10.4 mm); higher hemoglobin (6.3 ± 2.2 vs. 6.0 ± 2.7 mmol/l) and prevalence of diabetes (20.6 vs. 12.8%, P ≤ 0.004) than patients without psoriasis. In multivariable Cox analysis, adjusting for age, sex, hemoglobin, diabetes, time-varying SBP, heart rate, study treatment and Sokolow-Lyon hypertrophy, psoriasis, treated as a time-varying covariate, was associated with a two-fold higher risk of new-onset atrial fibrillation [hazard ratio: 1.97 (95% confidence interval (CI): 1.18-3.30), P=0.01]. Propensity-matched analysis yielded similar results (odds ratio: 3.49, 95% CI 1.24-9.81, P=0.018). Psoriasis has a similar prevalence in hypertensive patients as in the general population. Psoriasis independently predicted new-onset atrial fibrillation despite lower age and electrocardiographic LVH in psoriasis patients than in patients without psoriasis.