Cardiovascular diseases

High blood pressure (hypertension) is a long-term condition in which blood is pumped through the arteries at a higher-than-normal pressure.

People with psoriasis have a 43 to 58 per cent increased risk of high blood pressure compared to the general population. As the severity of psoriasis increases so does the likelihood of uncontrolled hypertension. ⁴

Sometimes, the cause of high blood pressure is unknown. Known causes include:

• Narrowing of the arteries to the kidneys
• Kidney disease
• Some hormonal conditions
• Some medicines
• Sleep apnoea
• Complications of pregnancy

Other risk factors for high blood pressure include:

• Other conditions: Such as thyroid problems, chronic kidney disease, metabolic syndrome, diabetes or obesity.
• Age: Blood pressure tends to rise with age.
• Family history and genetics: High blood pressure often runs in families.
• Lifestyle choices: Such as smoking, poor diet and lack of regular exercise.⁵

Blood pressure is measured in mmHg, which is short for “millimetres of mercury”. It is given as two figures:

• Systolic— the pressure as the heart pumps blood through the arteries.
• Diastolic— the pressure in the arteries when the heart relaxes between beats.

Blood pressure measurements are given as the systolic pressure “over” the diastolic pressure. For example, 120/80mmHg would be reported as “120 over 80”.⁶

For most people, a healthy or “normal” blood pressure level when at rest is:

• a systolic blood pressure under 130mmHg
• a diastolic blood pressure under 85mmHg

High blood pressure is a blood pressure reading of 140/90mmHg or more.⁶

It is normal for blood pressure levels to change throughout the day. Other factors such as activity levels, stress and general health can also affect blood pressure.

While high blood pressure usually does not cause symptoms itself; symptoms of very high blood pressure can include:

• Headaches
• Dizziness
• Nosebleeds
• Vision problems

High blood pressure is a major risk factor for cardiovascular, metabolic and other conditions.

How often should you have your blood pressure checked?

You should have your blood pressure checked every two years if your blood pressure is in the healthy range and:

• You have no other risk factors for cardiovascular disease, and
• You have never been diagnosed with high blood pressure before, and
• You don’t have any family history of high blood pressure.

Your doctor can also check your blood pressure during routine visits.

You should have your blood pressure checked more frequently (such as every 12 months or as directed by your doctor) if:

• You blood pressure is “high to normal” (or higher – for example 140/95), or
• You have other risk factors for cardiovascular disease, such as a personal or family history of high blood pressure, stroke or heart attack.⁷

You can have your blood pressure checked as part of a Heart Health Check. A Heart Health Check is a 20-minute check up with your doctor (GP) which is subsidised by Medicare.

You can also use a portable blood pressure monitor at home.

Ask your doctor for advice on the ideal blood pressure range for you and your current circumstances.

Atherosclerosis is the gradual buildup of plaque in the walls of the arteries (the vessels that carry oxygen-rich blood throughout the body). It is not a cardiovascular condition but it can lead to a range of cardiovascular and other conditions.

Plaque is a sticky substance primarily made of fat, cholesterol and calcium. As it builds up, it causes artery walls to become harder and thicker. People with psoriasis have an increased arterial stiffness compared to otherwise healthy people and there is a positive link between arterial stiffness and psoriasis disease duration.²

Other risk factors for atherosclerosis include:

• Other conditions: Such as high blood pressure, diabetes or metabolic syndrome.
• Age: Being a male over 45 or a female over 55.
• Genetics: Such as people with a close relative with cardiovascular disease.
• Lifestyle choices: Smoking, poor diet and lack of regular exercise.⁸

Left untreated, atherosclerosis can cause restricted blood flow and blood clots that block oxygen supply to organs. As arteries become blocked, symptoms can start to become noticeable in different parts of the body.

Atherosclerosis has a different name depending on the affected arteries. Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain. Coronary artery disease is plaque buildup in the arteries of the heart.

Atherosclerosis symptoms may include:

• Heart: Chest pain, palpitations, shortness of breath, dizziness, pain in the upper torso.
• Digestive system: Belly pain, nausea, bloating, diarrhoea, unexplained weight loss.
• Lower limbs: Muscle pain, sores or infections on the feet, changes in skin colour, burning or aching pain in the feet and toes when resting.
• Kidneys: Drowsiness, headaches, unexplained weight loss, digestive upsets, urinary changes.
• Brain: Dizziness, slurred speech, muscle weakness on one side of the body, vision loss in one eye, severe headache.⁸

One of the main causes of a heart attack (myocardial infarction) is plaque buildup in the blood vessels that supply blood to the heart (a type of atherosclerosis called coronary heart disease).

When the plaque forms a clot, it restricts the blood flow to the heart, causing the heart muscle to be severely damaged or die. This means the heart can no longer supply enough blood to the rest of the body. During a heart attack, the heart can usually continue to beat. However, if it stops beating regularly (cardiac arrest), it causes the lungs and brain to stop functioning, followed by death if not treated urgently.

Heart attack symptoms can vary from person to person. Some people do not have any symptoms. Symptoms can vary in intensity and can come and go.

Symptoms of a heart attack may include:

• Chest pain — pressure, heaviness, tightness, squeezing or a crushing feeling in the middle of the chest.
• Pain in other areas such as the arms, shoulders, back, neck, jaw or stomach
• Coughing, a choking sensation or difficulty breathing
• Suddenly feeling dizzy, faint, light-headed or anxious
• Nausea or vomiting
• A feeling of indigestion
• Sweating or a cold sweat
• Irregular or fast heartbeat (palpitations)⁹

Females are less likely than males to have chest pain but may be more likely to experience:

• Pain in the back, neck, jaw or both arms
• Shortness of breath or nausea
• Feeling very tired
• Pressure or a tight feeling in the chest⁹

It is not possible to diagnose a heart attack based on symptoms alone. It is a life-threatening issue, so call 000 if you think you or someone you are with is having a heart attack.

The most common causes of strokes are when blood flow to the brain is blocked (ischemic stroke) or there is sudden bleeding in the brain (haemorrhagic stroke).

Strokes can affect anyone at any time but are more likely to occur in people with common cardiovascular risk factors. People with severe psoriasis and significant inflammation have an increased risk of stroke.¹⁰

The type of symptoms depends on the type of stroke and the area of the brain that is affected.

Signs of a stroke may include:

• Sudden confusion, trouble speaking, or trouble understanding speech
• Sudden numbness or weakness, especially on one side of the body
• Sudden severe headache with no known cause
• Sudden trouble seeing from one or both eyes
• Sudden trouble walking, dizziness or loss of balance or coordination¹¹

Strokes must be treated urgently as they cause damage to the brain and may lead to death. The more serious the stroke, the higher the risk of brain damage and subsequent complications such as:

• Further blood clots
• Loss of bowel or bladder control
• Loss of bone strength or density (leading to osteopenia or osteoporosis)
• Muscle weakness or paralysis
• Seizures
• Problems with speaking, thinking or memory
• Loss of vision, hearing or touch
• Swelling in the brain¹¹

Call 000 for urgent medical attention if you think you or someone you are with is having a stroke.

¹ Australian Institute of Health and Welfare: Heart, Stroke and Vascular Disease – Australian facts. https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/summary

² Hu SC, Lan CE. Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment. Int J Mol Sci. 2017 Oct 21;18(10):2211. doi: 10.3390/ijms18102211. PMID: 29065479; PMCID: PMC5666891. https://pmc.ncbi.nlm.nih.gov/articles/PMC5666891/#sec2-ijms-18-02211

³ Cleveland Clinic: Cardiovascular Disease. https://my.clevelandclinic.org/health/diseases/21493-cardiovascular-disease

⁴ National Psoriasis Foundation: Understanding Psoriasis Comorbidities.  https://www.psoriasis.org/understanding-psoriasis-comorbidities

⁵ NIH National Heart, Lung and Blood Institute: High Blood Pressure – Causes and Risk Factors. https://www.nhlbi.nih.gov/health/high-blood-pressure/causes

⁶ Healthdirect: What is a Healthy Blood Pressure? https://www.healthdirect.gov.au/what-is-a-healthy-blood-pressure

⁷ Better Health Channel: Blood Pressure. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/blood-pressure

⁸ Cleveland Clinic: Atherosclerosis. https://my.clevelandclinic.org/health/diseases/16753-atherosclerosis-arterial-disease

⁹ Healthdirect: Heart Attack. https://www.healthdirect.gov.au/heart-attack

¹⁰ Rasyid, Al, Mesiano, Taufik, Kurniawan, Mohammad, Hidayat, Rakhmad, Eddy Yunus, Reyhan, Novianto, Endi, Ocktafiani, Ocktafiani, Wiyarta, Elvan, Harris, Salim, Comprehensive Management of Acute Ischemic Stroke in Psoriatic Patient, Case Reports in Dermatological Medicine, 2023, 6580971, 5 pages, 2023.  https://onlinelibrary.wiley.com/doi/10.1155/2023/6580971

¹¹ NIH National Heart, Lung and Blood Institute: Stroke Symptoms. https://www.nhlbi.nih.gov/health/stroke/symptoms