Blood Pressure Drugs Differ Between Psoriasis Patients, Large US Study Finds

Psoriasis has long been recognized as more than a skin condition. Over the past two decades, researchers have steadily built the case that the chronic inflammatory disease, which drives the rapid turnover of skin cells and produces scaly plaques, is entangled with the health of blood vessels, the heart, and the metabolic system. People with psoriasis are more likely to develop hypertension, diabetes, and cardiovascular disease, and they tend to carry these diagnoses at younger ages. A new analysis published in the Archives of Dermatological Research adds a fresh dimension to this picture by asking a deceptively simple question: when people with psoriasis and people without the condition both receive treatment for high blood pressure, do they end up on the same medications?

The study, led by Christine Hodelin and Marina Z. Joel, co-first authors from Yale School of Medicine and Johns Hopkins University School of Medicine, together with Maureen E. Canavan and principal investigator Jeffrey M. Cohen, drew on the All of Us Research Program, the sweeping National Institutes of Health initiative that has recruited hundreds of thousands of participants across the United States. All of Us is unusual among large biomedical datasets because it deliberately seeks diversity in its cohort, enrolling volunteers who have historically been underrepresented in medical research. That breadth makes it a powerful tool for spotting patterns in how real-world patients are treated, rather than how carefully selected clinical trial populations are treated.

The researchers designed their investigation as a cross-sectional study, a snapshot in time that compares groups of people at a single point rather than following them forward over years. Cross-sectional designs have well-understood strengths and limitations. They are efficient and can capture large numbers of participants, which makes them ideal for mapping patterns of care. What they cannot do is establish cause and effect or track how an individual’s treatment changes as their disease evolves. The team followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, the widely used STROBE checklist that sets standards for how observational research should be designed, analyzed, and reported, signaling an effort to keep the analysis transparent and reproducible.

The focus on antihypertensive medication choices is not arbitrary. Dermatologists and cardiologists have known for years that some blood pressure drugs can influence psoriasis itself. Beta-blockers, a mainstay class of hypertension therapy that slows the heart and blunts stress hormones, have been repeatedly linked in pharmacovigilance studies and systematic reviews to the onset or worsening of psoriatic disease. A 2022 systematic review and network meta-analysis published in the British Journal of Clinical Pharmacology examined antihypertensive drug use and psoriasis across many studies and found meaningful signals tying certain drug classes to psoriasis risk. If prescribing patterns differ between patients with and without psoriasis, it could reflect clinicians deliberately steering away from drugs that might aggravate the skin disease, or it could reflect differences in the underlying cardiovascular profiles of the two groups.

There is also a harder clinical problem lurking beneath the prescription data. Earlier work, including a population-based study in the United Kingdom published in JAMA Dermatology in 2015 by Takeshita and colleagues, found that psoriasis severity was associated with poorer hypertension control. In other words, even when people with psoriasis are diagnosed and treated for high blood pressure, their blood pressure appears harder to bring down. Whether that reflects true treatment resistance driven by chronic inflammation, differences in adherence, differences in the intensity of therapy, or some combination of these remains an open question. Understanding which medications patients actually receive is a necessary first step toward answering it, because the mix of drugs a patient takes shapes both the odds of control and the side effects they must tolerate.

The 2017 guideline from the American College of Cardiology and the American Heart Association, which the study cites, lowered the diagnostic threshold for hypertension and reshaped treatment decisions across the United States. Under those guidelines, first-line therapy typically begins with thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers, with beta-blockers generally reserved for patients who have compelling indications such as coronary artery disease or heart failure. Against that backdrop, any systematic difference in prescribing between psoriasis patients and others becomes clinically meaningful. It could hint at a hidden layer of clinical judgment, where prescribers weigh dermatologic comorbidities alongside cardiovascular ones, or it could reveal gaps in care that contribute to the worse blood pressure outcomes previously documented in this population.

The choice of the All of Us dataset matters for another reason. Traditional claims databases, which insurers and researchers often use to study medication patterns, capture billing records rather than the full clinical context, and they skew toward insured populations. All of Us combines electronic health record data, survey responses, and participant-reported information within a cohort that spans a wide range of ages, ancestries, and socioeconomic backgrounds. For a question that sits at the intersection of dermatology and cardiology, two specialties that frequently operate in separate clinical lanes, a dataset that reflects the messy reality of combined care is exactly what is needed. The study’s authors acknowledge the All of Us participants directly, noting that the research would not have been possible without their contributions.

The work is framed as a research letter, a compact format that journals reserve for focused findings that do not require a full-length article. Research letters trade depth of secondary analysis for speed and clarity, and they often serve as hypothesis-generating studies that larger, longitudinal projects later build upon. The funding for the project came in part from the Richard K. Gershon Endowed Medical Student Research Fellowship at Yale, supporting the first author’s contribution. The corresponding author, Jeffrey M. Cohen of Yale’s Department of Dermatology and Department of Biomedical Informatics and Data Science, has disclosed consulting relationships with several pharmaceutical companies, including Novartis, Sanofi, and Johnson & Johnson, all of which market psoriasis therapies, while the remaining authors reported no conflicts of interest.

What makes this line of research resonate beyond the specialty journals is the growing recognition that inflammatory skin disease and cardiovascular medicine are inseparable. Psoriasis affects an estimated two to three percent of the global population, and the systemic inflammation it generates is now understood to accelerate atherosclerosis, the buildup of plaque in artery walls that underlies heart attacks and strokes. International guidelines increasingly recommend that dermatologists screen psoriasis patients for cardiovascular risk factors, and that cardiologists think about inflammation when patients prove difficult to treat. Studies that map how care is actually delivered, such as this one, sit at the junction of those two agendas.

The study also highlights the quiet revolution happening in how such questions get answered. A decade ago, comparing medication patterns across a diverse national cohort would have required assembling a multicenter registry over many years. Today, programs like All of Us allow a small team of dermatologists and data scientists to run the analysis from a research workbench, with the results published and the underlying data available to any registered researcher who wants to interrogate or extend them. That openness accelerates the cycle from observation to hypothesis to intervention. If the prescribing patterns documented here do differ between patients with and without psoriasis, the next generation of studies can ask whether tailoring antihypertensive therapy to the dermatologic profile of a patient improves not just their skin, but their long-term heart health as well.

Subject of Research: Antihypertensive medication use patterns in hypertensive patients with and without psoriasis

Article Title: Antihypertensive use patterns in hypertensive patients with and without psoriasis: a cross-sectional study using the All of Us research program

Article References: Hodelin, C., Joel, M. Z., Canavan, M. E., & Cohen, J. M. (2026). Antihypertensive use patterns in hypertensive patients with and without psoriasis: a cross-sectional study using the All of Us research program. Archives of Dermatological Research, 318(1), Article 505. https://doi.org/10.1007/s00403-026-05000-z

Image Credits: AI Generated

DOI: 10.1007/s00403-026-05000-z

Keywords: psoriasis, hypertension, antihypertensive drugs, All of Us Research Program, cardiovascular disease, dermatology, beta-blockers, cross-sectional study, blood pressure control, systemic inflammation, epidemiology, drug safety