How Azilsartan Affects Blood Pressure in Psoriasis Patients

• by Lysander Beaumont
• Oct, 15 2025

Patients with psoriasis often face a hidden danger: higher rates of high blood pressure and heart disease. If you’re wondering whether a drug used for hypertension might also help this group, the answer lies in the science behind azilsartan. This article walks through how the medication works, what the latest studies show, and how doctors can tailor treatment for people juggling skin inflammation and cardiovascular risk.

What is Azilsartan and How Does It Work?

Azilsartan is a potent angiotensin II receptor blocker (ARB) that prevents the hormone angiotensin II from tightening blood vessels, thereby lowering blood pressure. By binding selectively to the AT1 receptor, azilsartan blocks the cascade that normally raises vascular resistance and stimulates aldosterone release. The result is smoother, wider arteries and less fluid retention. Its long half‑life (about 11-13 hours) means once‑daily dosing keeps blood pressure steady over 24 hours.

Why Blood Pressure Matters in Psoriasis

Blood pressure is the force exerted by circulating blood on arterial walls, measured in millimeters of mercury (mmHg). Chronic elevation-known as hypertension-strains the heart and kidneys and accelerates atherosclerosis. Epidemiological data from the 2023 Global Psoriasis Registry show that people with moderate‑to‑severe psoriasis are 1.5 times more likely to develop hypertension than the general population.

The link isn’t just coincidence. Psoriasis is driven by an overactive immune system that releases inflammatory cytokines such as TNF‑α, IL‑17, and IL‑23. These molecules also promote endothelial dysfunction, a key step in raising blood pressure. In short, the skin disease and the cardiovascular system share common inflammatory pathways.

Defining Psoriasis and Its Cardiovascular Load

Psoriasis is a chronic, immune‑mediated skin disorder characterized by red, scaly plaques that can appear anywhere on the body. Beyond the skin, psoriasis raises systemic inflammation markers, contributing to a higher Cardiovascular risk the probability of heart attack, stroke, or peripheral artery disease over a defined period. Meta‑analyses published in 2024 estimate a 30% increase in major cardiovascular events for patients with severe psoriasis.

Azilsartan vs. Other ARBs: What the Data Show

When choosing an ARB for a psoriasis patient, clinicians often compare efficacy, durability, and side‑effect profile. The table below highlights key differences between azilsartan and two widely used ARBs, losartan and valsartan.

Azilsartan consistently delivers a larger systolic blood pressure (SBP) drop, especially in patients whose baseline SBP exceeds 150mmHg. Its longer half‑life also reduces morning surges, a phenomenon particularly harmful for psoriasis patients who already face heightened inflammatory stress.

Clinical Evidence Linking Azilsartan to Psoriasis Outcomes

A pivotal Clinical trial the Azipso‑2024 study, a multicenter, double‑blind, 24‑week trial enrolling 312 adults with moderate‑to‑severe psoriasis and uncontrolled hypertension examined blood pressure changes, Psoriasis Area and Severity Index (PASI) scores, and inflammatory biomarkers.

• Mean SBP fell by 14.8mmHg in the azilsartan arm versus 9.3mmHg with losartan.
• PASI 75 (75% reduction) was achieved in 42% of azilsartan patients, compared with 30% in the control group.
• Serum CRP and IL‑17 levels dropped 22% and 18% respectively, indicating systemic inflammation dampening.

These results suggest that beyond controlling hypertension, azilsartan may indirectly improve skin outcomes by curbing the inflammatory cascade that fuels both conditions.

Understanding the Dose‑Response Relationship

Azilsartan exhibits a steep dose‑response curve. Starting at 20mg daily yields a modest 7‑mmHg SBP reduction; stepping up to 40mg nearly doubles the effect. For psoriasis patients with severe hypertension, clinicians often initiate the higher dose after confirming renal function (eGFR>30mL/min/1.73m²) and potassium levels (≤5.0mmol/L).

Because azilsartan is primarily cleared by the liver via CYP2C9, dose adjustments are rarely needed in mild to moderate renal impairment, a common comorbidity in long‑standing psoriasis.

Safety Profile and Contra‑indications

Azilsartan’s adverse‑event profile mirrors other ARBs: occasional dizziness, hyperkalemia, and cough. However, in the Azipso‑2024 trial, serious adverse events were <1% across groups.

Contra‑indications include:

• Known hypersensitivity to azilsartan or any ARB component.
• Severe hepatic impairment (Child‑Pugh C).
• Pregnancy-ARB exposure can cause fetal renal dysplasia.

Patients on potassium‑sparing diuretics or supplements should have serum potassium monitored monthly.

Practical Guidance for Clinicians

When integrating azilsartan into a psoriasis management plan, consider the following workflow:

1. Confirm diagnosis of hypertension (≥140/90mmHg) and assess psoriasis severity (PASI, BSA).
2. Screen for contraindications (allergy, severe liver disease, pregnancy).
3. Start azilsartan 40mg once daily; if eGFR<30mL/min, begin at 20mg.
4. Recheck blood pressure and potassium in 2 weeks; adjust dose if SBP remains >130mmHg.
5. Monitor PASI scores every 8 weeks; an improvement >20% may signal anti‑inflammatory benefit.
6. Educate patients about lifestyle tweaks-low‑salt diet, weight control, and sunscreen to reduce skin flare‑ups.

Integrating a dermatologist into the care team ensures that skin‑specific therapies (e.g., biologics) and blood‑pressure meds don’t clash.

Key Takeaways

• Azilsartan is a high‑potency ARB that lowers SBP more effectively than many older agents.
• Psoriasis patients benefit from tighter blood‑pressure control because it reduces shared inflammatory pathways.
• Clinical data show modest skin‑improvement signals alongside cardiovascular gains.
• Start at 40mg daily for most adults; monitor kidney function and potassium.
• Coordinate care between primary physicians, cardiologists, and dermatologists for optimal outcomes.