Acta Dermato-Venereologica 99-3CompleteContent | Page 19

SHORT COMMUNICATION 329 High Blood Pressure in Normal-weight Children with Psoriasis Francesca CAROPPO 1 , Laura VENTURA 2 and Anna BELLONI FORTINA 1 Pediatric Dermatology Unit – Department of Medicine DIMED, and 2 Department of Statistics, University of Padova, Via Gallucci, 4, IT-35128 Padova, Italy. E-mail: [email protected] 1 Accepted Oct 16, 2018; E-published Oct 17, 2018 Both adults and children with psoriasis are at risk for co- morbidities, including obesity, hypertension, hyperlipidae- mia, diabetes mellitus, metabolic syndrome, non-alcoholic fatty liver disease (1–12). Since obesity is a known risk factor for most of these comorbidities, it would be useful to determine whether psoriasis is an independent risk factor for some or all of them (6). There is some evidence of psoriasis as an indepen- dent risk factor for comorbidities (1, 6), but most of the studies are retrospective or have limitations due to inter- institutional variations in data collecting methodologies, data interpretation, different populations studied or limited number of patients. We performed a single-centre study screening for children with psoriasis who had high blood pressure, but without over-weight, obesity or central obesity, and age- and sex- matched controls. METHODS Among children consecutively referred to the Pediatric Derma- tology Unit, Padua University, Padua, Italy, 52 children with plaque-type psoriasis were identified, without over-weight, obesity or central obesity (between the ages of 4 and 16 years) and 52 age- and sex-matched children without psoriasis (control group), also without over-weight, obesity or central obesity. The control group was recruited among children consecutively attending the Pediatric Dermatology Clinic for non-inflammatory diseases (i.e. warts, naevi, moles, etc.). Children with and without psoriasis were from the same geographical area, with similar demographic characteristics and, presumably, similar lifestyles. The following data were collected for each patient: physical exa- mination, height, body weight, waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), duration and severity of psoriasis, diastolic blood pressure (DBP), and systolic blood pressure (SBP). Psoriasis severity was classified as mild or moderate-to-severe according to the Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA). When PASI was ≥ 10 or/and BSA was >10 psoriasis was designated as moderate-to-severe (4). Duration of disease was calculated in months, considering the onset of initial clinical symptoms of psoriasis. None of the children was using or had used systemic medications that could increase blood pressure (e.g. corticosteroids, cyclosporine, etc.). BMI allowed us to classify children as normal-weight, over- weight, or obese according to the BMI cut-offs of the 2012 Interna- tional Obesity Task Force (13). WC was measured twice, midway between the lowest border of the rib cage and the upper border of the iliac crest, at the end of normal expiration, using inextensible anthropometric tape with the patients standing erect and relaxed with their arms at their sides and feet positioned close together. The mean values were considered for analysis (4). Evaluation of central obesity was performed using WHtR, calculated as WC divided by height. Patients with a WHtR ≥ 0.5 were classified as having central obesity (4). Exclusion criteria for patients in both groups were: children with overweight, obesity, or central obesity (WHtR ≥ 0.5), other inflammatory or autoimmune diseases and smoking habit. The measurement of diastolic and systolic blood pressure (BP) was performed using an aneroid sphygmomanometer with an appropriate sized cuff for each patient. BP was measured in the right arm by using standard measurement practices. The conditions of blood pressure measurements were similar between groups of children. When the initial BP was elevated (≥ 95 th percentile), 2 additional measurements were performed at the same visit. Mean values were considered for analysis. BP values were categorized as normal BP (> 50 and ≤ 90 th sex, age and height specific percentile), elevated BP (> 90 th sex, age and height specific percentile), stage 1 hypertension (stage 1 HTN) (≥ 95 th sex, age and height specific percentile), stage 2 hypertension (stage 2 HTN) (≥ 95 th sex, age and height specific percentile +12 mmHg) (14). Demographic and clinical data were summarized using percenta- ges and means and standard deviations. Differences in quantitative variables between subjects groups were assessed with Student’s t-test or Mann–Whitney test, according to the Shapiro-Wilk test of normality. For categorical data the association between variables was assessed with the odds ratio and tested using the Fisher’s exact test. A logistic regression model was used to determine which covariates were associated with psoriasis and control groups. A receiver operating characteristic (ROC) curve analysis was perfor- med to assess the discrimination ability of the logistic regression. Analysis of covariance (ANCOVA) regression models were used to study how the dependent variables weight, BMI, WHtR, systolic blood pressure and diastolic blood pressure depend on both age and psoriasis and control group. Statistical significance was set at p < 0.05. Data were analysed using the statistical software R. RESULTS Mean age of the children was 10.60  ±  2.98 years and 27 (51.92%) were girls. Mean systolic blood pressure was 112.27  ±  9.84 mmHg in children with psoriasis and 106.17  ±  9.72 mmHg in controls. Mean value of diastolic blood pressure was 71.01  ±  6.20 mmHg in children with psoriasis and 65.48  ±  6.94 mmHg in controls (Table I). Among psoriatic children, 28 (53.85%) had normal blood pressure and 24 (46.15%) had systolic or diastolic elevated blood pressure/stage 1 HTN; 8 (15.38%) of these, had both systolic elevated BP/stage 1 HTN and diastolic elevated BP/stage 1 HTN. Among controls, 46 (88.46%) had normal blood pressure and 6 (11.54%) had systolic or diastolic elevated BP/stage 1 HTN; 1 (1.92%) of these had both systolic elevated BP/stage 1 HTN and diastolic elevated BP/stage 1 HTN. Children with psoriasis, compared with children with­out, had a statistically significant higher prevalence of systolic This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3076 Acta Derm Venereol 2019; 99: 329–330