Antihypertensive drug use and psoriasis: A systematic review, meta- and network meta-analysis

Aims: Diverse genetic and/or external factors may induce psoriasis. Drug exposure is 1 such prominent external factor; antihypertensive drugs are reportedly associated with psoriasis, but study results have been inconsistent. In this context, we investigated the associations between antihypertensive drugs and incidence if psoriasis via a systematic literature review and meta-analysis. Methods: Literature search in databases such as PubMed, Embase and Web of Science was conducted on 8 January 2021, and obtained data were pooled for meta- and network meta-analysis. Fixed- or random effect models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for evaluating the strength of the associations between antihypertensive drugs and psoriasis incidence. In addition to meta-analysis, Bayesian network meta-analysis was performed. ResultsThirteen eligible studies were included for meta-analysis with 6 378 116 individuals and 8 studies for network meta-analysis with 5 615 918 individuals. All antihypertensive drugs were significantly associated with psoriasis incidence. In a meta-analysis, the pooled ORs were 1.67 (95% CI: 1.31–2.13) for angiotensin-converting enzyme (ACE) inhibitors, 1.40 (95% CI: 1.20–1.63) for β-blockers, 1.53 (95% CI: 1.23–1.89) for calcium-channel blockers (CCBs), and 1.70 (95% CI: 1.40–2.06) for thiazide diuretics. For the comparative risks of psoriasis among antihypertensive drugs in the network meta-analysis, ORs were 2.09 (95% CI: 1.39–3.18) for ACE inhibitors, 1.35 (95% CI: 0.99–1.91) for BBs, 1.53 (95% CI: 1.07–2.24) for CCBs and 1.80 (95% CI: 1.23–2.66) for thiazide diuretics. Conclusion: This study confirmed the associations between antihypertensive drugs and psoriasis; ACE inhibitors, BBs, CCBs and thiazide diuretics increased the risk of psoriasis. Therefore, antihypertensive drug users should be carefully monitored for psoriasis.