Bidirectional Relationship between Severe Resistant Hypertension and Extensive Psoriasis at Young Man: A Case Study

Abstract

Introduction: Hypertension is a common manifestation in patients with psoriasis. The bidirectional relationship between psoriasis and hypertension, by inflammatory mechanism and by the effect of democratic therapy, is proven in several studies. Our clinical case study illustrates this relationship and its adequate management. Case Presentation:  We report the case of a 42-year-old man suivi for unbalanced diabetes (HbA1c: 8.5%) and psoriasis treated with corticosteroids for the last 11 years. Presented to our cardiology department for severe hypertension and extensive psoriasis lesions. On examination, he was clinically dyspneic NYHA-II, severe hypertension at 170/112 mmHg, tachycardia up to 105 beats per minute. His skin examination noted the presence of well- defined, symmetrical, erythematous patches covered with silvery scales affecting almost the entire body surface, including face and scalp. The echocardiography showed important cardiac hypertrophy with a normal contractility, his left ventricle ejection fraction estimated at 58%. In view of his young age, we lanced a secondary hypertension testicular objective the presence of secondary hyper-aldosteronism, the cortisol, metanephrine and normetanephrine were all in normal levels. On imaging, the Doppler ultrasound of the renal arteries showed no renal arteries stenosis, CT scan of the adrenal glands demonstrate bilateral adrenal hypertrophy without detectable mass. The evolution was marked by the control of his hypertension after the psoriasis relapse, with a blood pressure of 129/65 mmHg under quadritherapy based on calcium channel blocker 10mg, ACEI 10mg, indapamide 5mg and carvedilol 6.25mg twice daily, aldactone 50mg/d. Discussion: The relationship between psoriasis and hypertension is bidirectional, hence the need for comprehensive and adequate management, especially in terms of the use of dermocorticoids in psoriasis, which can unbalance hypertension control. There is evidence that the severity of psoriasis, as determined objectively by body surface area, has a significant impact on the control of hypertension. especially those with more extensive skin involvement. Conclusion: There is evidence that the severity of psoriasis, as determined objectively by body surface area, has a significant impact on the control of hypertension. especially those with more extensive skin involvement.