Wiener klinische Wochenschrift

, Volume 124, Issue 23–24, pp 822–829 | Cite as

Non-dipping nocturnal blood pressure in psoriasis vulgaris

  • Ahmet Bacaksiz
  • Mehmet Akif Vatankulu
  • Osman Sonmez
  • Ercan Erdogan
  • Abdurrahman Tasal
  • Murat Turfan
  • Gokhan Ertas
  • Emrah Sevgili
  • Didem Dizman
  • Nahide Onsun
original article



Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris.


Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10 % between the average day and night systolic BP.


Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0 mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5 mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1 %, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation.


Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.


Psoriasis Ambulatory blood pressure monitoring Prehypertension Non-dipping nocturnal blood pressure Cardiovascular risk 

Fehlendes Dipping des nächtlichen Blutdrucks bei Psoriasis vulgaris



Psoriasis vulgaris ist eine der häufigsten chronischen entzündlichen Hauterkrankungen. Patienten mit Psoriasis haben ein erhöhtes Risiko einer Hypertonie und kardiovaskulärer Ereignisse. Der Blutdruck (RR) hat normaler Weise einen zirkadianen Rhythmus, charakterisiert durch niedrigere Werte während der Nacht. Ein Fehlen dieses Abfalls des RRs („Non-Dipping“) beschleunigt die Entwicklung einer Hypertonie und kardiovaskulärer Erkrankungen. Ziel dieser Studie ist es, den zirkadianen Rhythmus des RRs bei normotensiven Patienten mittleren Alters mit Psoriasis vulgaris zu evaluieren.


Siebzig erwachsene Patienten mit Psoriasis vulgaris (= Gruppe 1) und 70 alters-und geschlechts-gematchte gesunde Personen (= Gruppe 2) wurden in die Studie aufgenommen. Bei allen Teilnehmern an der Studie wurde ein ambulantes 24-h RR Monitoring durchgeführt. „Non-Dippers“ wurden definiert als jene, die weniger als 10 % Abfall des systolischen RRs nachts – im Vergleich zum mittleren systolischen RR während des Tages aufwiesen.


Obwohl die mittleren 24 h RR Werte in beiden Gruppen ähnlich waren, waren die nächtlichen RR Werte bei den Psoriasis Patienten signifikant höher (115,1 ± 7,7 vs. 109,9 ± 6,0 mmHg und 72,1 ± 7,0 vs. 67,6 ± 5,5 mmHg, respektive; p < 0,05). Das „Non-Dipping“ Muster der RR Veränderungen war bei Psoriasis vulgaris signifikant häufiger als in der Kontrollgruppe (65,9 vs. 34,1 %, p < 0,01). Der Schweregrad der Psoriasis und der BMI waren unabhängige Prädiktoren einer gestörten nächtlichen RR Regulation.


Patienten mit Psoriasis vulgaris hatten erhöhte nächtliche RR Werte und Herzfrequenz. Dies ist die 1. Studie, die ein Fehlen des nächtlichen RR Abfalls bei normotensiven Psoriasis Patienten zeigt.


Psoriasis Ambulantes 24-h blutdruck monitoring Fehlendes dipping des nächtlichen blutdruck Kardiovaskulären risikos 


Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Soylu A, Yazici M, Duzenli MA, Tokac M, Ozdemir K, Gok H. Relation between abnormalities in circadian blood pressure rhythm and target organ damage in normotensives. Circ J. 2009;73(5):899–904.PubMedCrossRefGoogle Scholar
  2. 2.
    Li L, Soonthornpun S, Chongsuvivatwong V. Association between circadian rhythm of blood pressure and glucose tolerance status in normotensive, non-diabetic subjects. Diabetes Res Clin Pract. 2008;82(3):359–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Sayk F, Becker C, Teckentrup C, Fehm HL, Struck J, Wellhoener JP, et al. To dip or not to dip: on the physiology of blood pressure decrease during nocturnal sleep in healthy humans. Hypertension. 2007;49(5):1070–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Cuspidi C, Meani S, Valerio C, Negri F, Sala C, Maisaidi M, et al. Body mass index, nocturnal fall in blood pressure and organ damage in untreated essential hypertensive patients. Blood Press Monit. 2008;13(6):318–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Kawano Y, Horio T, Matayoshi T, Kamide K. Masked hypertension: subtypes and target organ damage. Clin Exp Hypertens. 2008;30(3):289–96.PubMedCrossRefGoogle Scholar
  6. 6.
    Viera AJ, Zhu S, Hinderliter AL, Shimbo D, Person SD, Jacobs DR Jr. Diurnal blood pressure pattern and development of prehypertension or hypertension in young adults: the CARDIA study. J Am Soc Hypertens. 2011;5(1):48–55.PubMedCrossRefGoogle Scholar
  7. 7.
    Hermida RC, Chayán L, Ayala DE, Mojón A, Domínguez MJ, Fontao MJ, et al. Association of metabolic syndrome and blood pressure nondipping profile in untreated hypertension. Am J Hypertens. 2009;22(3):307–13.PubMedCrossRefGoogle Scholar
  8. 8.
    Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C. Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study. Am J Hypertens. 2006;19(3):243–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al. Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens. 1997;10(11):1201–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Schön MP, Boehncke WH. Psoriasis. N Engl J Med. 2005;352(18):1899–912.PubMedCrossRefGoogle Scholar
  11. 11.
    Rosa DJ, Machado RF, Matias FA, Cedrim SD, Noronha FL, Gaburri D, et al. Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis. J Eur Acad Dermatol Venereol. 2012;26(3):348–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejowska AS, Zalewska A. Heart rate and arrhythmia in patients with psoriasis vulgaris. Arch Med Res. 2007;38(1):64–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Ahlehoff O, Gislason GH, Jørgensen CH, Lindhardsen J, Charlot M, Olesen JB, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Eur Heart J. 2012;33(16):2054–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298(7):321–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Zindancı I, Albayrak O, Kavala M, Kocaturk E, Can B, Sudogan S, et al. Prevalence of metabolic syndrome in patients with psoriasis. ScientificWorldJournal. 2012;2012:312463.PubMedGoogle Scholar
  16. 16.
    Louden BA, Pearce DJ, Lang W, Feldman SR. A Simplified Psoriasis Area Severity Index (SPASI) for rating psoriasis severity in clinic patients. Dermatol Online J. 2004;10(2):7.PubMedGoogle Scholar
  17. 17.
    Amornpinyokeit N, Asawanonda P. 8-Methoxypsoralen cream plus targeted narrowband ultraviolet B for psoriasis. Photodermatol Photoimmunol Photomed. 2006;22:285–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003;49:206–12.PubMedCrossRefGoogle Scholar
  19. 19.
    Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.PubMedCrossRefGoogle Scholar
  20. 20.
    Madin K, Iqbal P. Twenty four hour ambulatory blood pressure monitoring: a new tool for determining cardiovascular prognosis. Postgrad Med J. 2006;82(971):548–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60.PubMedCrossRefGoogle Scholar
  22. 22.
    Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462–536.PubMedGoogle Scholar
  23. 23.
    Mittal BV, Singh AK. Hypertension in the developing world: challenges and opportunities. Am J Kidney Dis. 2010;55(3):590–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Pierdomenico SD, Cuccurullo F. Ambulatory blood pressure monitoring in type 2 diabetes and metabolic syndrome: a review. Blood Press Monit. 2010;15(1):1–7.PubMedCrossRefGoogle Scholar
  25. 25.
    O’Brien E. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med. 2011;269(5):478–95.CrossRefGoogle Scholar
  26. 26.
    Liu T, Li G. Psoriasis, inflammation, and atrial fibrillation. Am J Cardiol. 2008;102(5):647.PubMedCrossRefGoogle Scholar
  27. 27.
    Flammer AJ, Ruschitzka F. Psoriasis and atherosclerosis: two plaques, one syndrome? Eur Heart J. 2012;33(16):1989–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Rico T, Marchione R, Kirsner RS. Vascular disease in psoriasis. J Invest Dermatol. 2009;129(10):2327.PubMedCrossRefGoogle Scholar
  29. 29.
    Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco AJ, Aguilar MD, et al. Integrated approach to comorbidity in patients with psoriasis. Actas Dermosifiliogr. 2012;103(Suppl 1):1–64.PubMedGoogle Scholar
  30. 30.
    Armstrong AW, Lin SW, Chambers CJ, Sockolov ME, Chin DL. Psoriasis and hypertension severity: results from a case-control study. PLoS One. 2011;6(3):e18227.PubMedCrossRefGoogle Scholar
  31. 31.
    Halıgür BD, Cicek D, Bulut S, Berilgen MS. The investigation of autonomic functions in patients with psoriasis. Int J Dermatol. 2012;51(5):557–63. doi:10.1111/j.1365-4632.2011.05111.x.PubMedCrossRefGoogle Scholar
  32. 32.
    Ena P, Madeddu P, Glorioso N, Cerimele D, Rappelli A. High prevalence of cardiovascular diseases and enhanced activity of the renin-angiotensin system in psoriatic patients. Acta Cardiol. 1985;40(2):199–205.PubMedGoogle Scholar
  33. 33.
    Boehncke WH, Boehncke S. Cardiovascular morbidity in psoriasis: epidemiology, pathomechanisms, and clinical consequences. G Ital Dermatol Venereol. 2008;143(5):307–13.PubMedGoogle Scholar
  34. 34.
    Enany B, El Zohiery AK, Elhilaly R, Badr T. Carotid intima-media thickness and serum leptin in psoriasis. Herz. 2012;37(5)527–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Gisondi P, Fantin F, Del Giglio M, Valbusa F, Marino F, Zamboni M, Girolomoni G. Chronic plaque psoriasis is associated with increased arterial stiffness. Dermatology. 2009;218(2):110–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Birkenhäger AM, Van Den Meiracker AH. Causes and consequences of a non-dipping blood pressure profile. Neth J Med. 2007;65(4):127–31.PubMedGoogle Scholar
  37. 37.
    Pickering TG, Kario K. Nocturnal non-dipping: what does it augur? Curr Opin Nephrol Hypertens. 2001;10(5):611–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Minamisawa K, Tochikubo O, Ishii M. Systemic hemodynamics during sleep in young or middle-aged and elderly patients with essential hypertension. Hypertension. 1994;23(2):167–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Ulusoy RE, Karabudak O, Yokusoglu M, Kilicaslan F, Kirilmaz A, Cebeci BS. Noninvasive assessment of impaired endothelial function in psoriasis. Rheumatol Int. 2010;30(4):479–83.PubMedCrossRefGoogle Scholar
  40. 40.
    Hermida RC, Chayán L, Ayala DE, Mojón A, Domínguez MJ, Fontao MJ, et al. Association of metabolic syndrome and blood pressure nondipping profile in untreated hypertension. Am J Hypertens. 2009;22(3):307–13.PubMedCrossRefGoogle Scholar
  41. 41.
    Schmitt J, Wozel G. The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology. 2005;210(3):194–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Ryan MJ. The pathophysiology of hypertension in systemic lupus erythematosus. Am J Physiol Regul Integr Comp Physiol. 2009;296(4):R1258–67.PubMedCrossRefGoogle Scholar
  43. 43.
    Bevelacqua V, Libra M, Mazzarino MC, Gangemi P, Nicotra G, Curatolo S, et al. Long pentraxin 3: a marker of inflammation in untreated psoriatic patients. Int J Mol Med. 2006;18(3):415–23.PubMedGoogle Scholar
  44. 44.
    Rihácek I, Frána P, Soucek M, Plachý M, Kianicka B. The diurnal variability of blood pressure in patients with hypertension and rheumatoid arthritis. Vnitr Lek. 2009;55(2):111–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • Ahmet Bacaksiz
    • 1
  • Mehmet Akif Vatankulu
    • 1
  • Osman Sonmez
    • 1
  • Ercan Erdogan
    • 1
  • Abdurrahman Tasal
    • 1
  • Murat Turfan
    • 1
  • Gokhan Ertas
    • 1
  • Emrah Sevgili
    • 1
  • Didem Dizman
    • 2
  • Nahide Onsun
    • 2
  1. 1.Department of Cardiology, Faculty of MedicineBezmiÂlem Foundation UniversityFatih/IstanbulTurkey
  2. 2.Department of Dermatology, Faculty of MedicineBezmiÂlem Foundation UniversityIstanbulTurkey

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