Antihypertensives and psoriasis
There are several classes of drugs that can be used to lower blood pressure in a person. Some examples of these are the: beta-blockers, calcium channel blockers (CCBs), and lipid-lowering medications such as HMG-CoA reductase inhibitors (“statins”).
As mentioned in a previous section, people with psoriasis have a higher risk of developing cardiovascular disease. It is likely that someone with psoriasis is also taking antihypertensive medications while being treated for psoriasis. Not all antihypertensives work in the same manner, so it is important to know the different mechanisms by which each elicits their effect.
The first class of drugs that will be discussed is the calcium channel blocker. There are many different medications under this class of drugs, with amlodipine (brand name: Norvasc) being one of the most well-known. The primary target of amlodipine is to prevent the binding of calcium ions to the receptors in the blood vessels. It effectively blocks the channels that are required to transport calcium, and the result is vasodilation and increased blood flow. It is especially useful in cases of angina and coronary artery disease, but is also used to treat systemic hypertension at a lesser degree.
The second class of drugs are beta-blockers. There are many different medications under this class of drugs, with atenolol (brand name: Tenormin) being a commonly used one. Atenolol is selective for beta-1 (β1) receptors, and works by blocking the receptor, which causes the heart to beat more slowly and reduces its workload. Its main use is for treating angina, tachycardia, and acute myocardial infarction, along with hypertension. However, beta-blockers can also precipitate type 2 diabetes mellitus, with atenolol being one of the most potent. It is not recommended to take non-selective or selective β1-receptor antagonists for people with type 2 diabetes mellitus, nor is it recommended to combine beta blockers with CCBs, because it may produce and additive effect and lead to an excessive drop in blood pressure and heart rate. Atenolol and some other beta-blockers have been linked to triggering flare ups in patients with psoriasis.
The third class of drugs are lipid-lowering medications, particularly the HMG-CoA reductase inhibitors. An example of an HMG-CoA reductase inhibitor is atorvastatin (brand name: Simvastatin). HMG-CoA reductase is an enzyme found in the body which is essential in the production of cholesterol. Simvastatin works by inhibiting this enzyme, and subsequently lowers the amount of cholesterol in the body. It is known that high cholesterol levels in the blood can lead to hypertension through the formation of plaque on the walls of the blood vessels. Plaque formation reduces the amount of blood that can flow through the blood vessel, and pressure begins to build up. Plaque can form embolisms which can block a blood vessel entirely, which prevents blood flow to an area and can cause ischemia, which is especially dangerous if it occurs in the vessels of the heart itself. The main adverse effects of statins are an increased risk of diabetes and muscle problems.
Cardiovascular disease and diabetes are risk factors for people with psoriasis, so it is important for a patient with psoriasis and any number of risk factors to seek consultation with their doctor regarding their proper medication regimen.