Background: Keloid represent a significant dermatological burden in Nigeria, with prevalence rates reaching 16% in some populations. While traditionally viewed as a localized skin disorder, emerging evidence suggests potential associations between keloid formation and systemic hypertension.

Objective: To assess any clinical association between keloid and hypertension.

Method: A hospital-based case-control study was conducted at Obafemi Awolowo University Teaching hospital Ile Ife and Federal Medical Centre, Owo, Nigeria, involving 180 participants (90 keloid patients and 90 age- and sex-matched controls). Comprehensive cardiovascular assessment included blood pressure measurements, hemodynamic parameters (cardiac output, stroke volume, cardiac index, stroke index and total peripheral resistance), and family history evaluation were done. Data were analyzed using Student's t-test, chi-square test, binary logistic regression, and multiple linear regression, with effect sizes calculated using Cohen's d and odds ratios.

Results: The mean age was 33.60±12.63 years in keloid patients versus 33.70±12.45 years in controls (p=0.934). Although hypertension prevalence was numerically higher in keloid patients (13.3% vs 8.9%, p=0.343), this difference was not statistically significant compared with controls. However, keloid patients demonstrated significantly elevated diastolic blood pressure (76.76±10.14 vs 73.87±8.64 mmHg, p=0.041) and total peripheral resistance (18.14±4.5 vs 15.77±3.5 mmHg/L/ min, p<0.001), alongside reduced cardiac output (5.18±1.13 vs 5.79±1.23 L/min, p=0.001), cardiac index (3.03±0.66 vs 3.40±0.70 L/min/m², p<0.001), stroke volume (69.47±16.83 vs 76.47±20.74 ml, p=0.005), and stroke index (40.17±10.29 vs 44.79±11.58 ml/m², p=0.005). Family history of both hypertension and keloids was significantly more prevalent in keloid patients (11.1% vs 1.1%, p<0.001). In regression analyses, keloid status independently predicted diastolic blood pressure (β=0.18, p=0.036), total peripheral resistance (β=0.41, p<0.001), and cardiac output (β=-0.29, p=0.001).

Conclusion: Keloid demonstrated strong associations with increased peripheral vascular resistance, elevated diastolic blood pressure, and reduced cardiac volume, cardiac index, stroke volume and stroke index, although not significantly related to systolic hypertension. These findings suggests early subclinical stage, predating overt systemic hypertension. Routine cardiovascular screening in keloid patients may be warranted, and longitudinal studies are needed to establish the causality of systemic hypertension in subjects with keloids.