COMBINATION OF NON-DIPPING PROFILE WITH HIGH NIGHTTIME SYSTOLIC BLOOD PRESSURE IN RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER CARDIOVASCULAR RISK

Abstract

Objective: Non-dipping profile is an important predictor of adverse cardiovascular (CV) outcomes. Its associations with subclinical vascular damage in rheumatoid arthritis (RA) are not known yet. We aimed to assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with CV risk in patients with RA. Design and method: The study group included 85 patients with RA (females 77.6%, aged 59.7 ± 14.3 years, HTN 65%, mean DAS-28 3.7 ± 1.1) and control group (40 patients matched by gender, age and risk factors). Office BP was measured with a validated oscillometric device, 24-hour ABPM by BPLab Vasotens. CV risk was calculated as mSCORE. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn < 120 mmHg (G2), non-dippers with SBPn > 120 (G3). p < 0.05 was considered significant. Results: Rate of BP control was 58% in RA and 67% in the controls (p = 0.48). Patients with RA vs controls were characterized by higher mean SBPn (123 ± 17 vs 112 ± 10 mmHg, p = 0.002), lower diurnal index (DI) (median 4 vs 7.5%, p = 0.006), higher rate of night hypertension (49.4 vs 12.5% (χ2 = 17, p < 0.001)). RA patients more often had non-dipping profile (DI < 10%): 83.5 vs 62.5%, (χ2 = 7.4, p = 0.02). In RA group patients with SBPn > 120mmHg had higher age (64.8 ± 12.6 vs 54.8 ± 14.3 years), office BP (142 ± 19/82 ± 11 vs 121 ± 14/76 ± 9mmHg), HTN duration (med 5.5 vs 0 years), mSCORE (med 6.1 vs 2.5%), p < 0.001 for trend. Patients with DI < 10% had higher age (60.8 ± 14.8 vs54.1 ± 10 years, p = 0.04). SBPn significantly correlated with age (r = 0.5), office SBP (r = 0.6) and DBP (r = 0.3), mSCORE (r = 0.5);non-dipping pattern–with age (r = 0.2). After adjustment by SBPn, no differences were observed between G1 and G2. Patients in G3 vs G1 had higher CRP (med 16.6 vs 6.7 mg/l, p = 0.03), mSCORE (med 7.1 vs2.3%, p < 0.001 for both); in G3 vs G2–higher mSCORE (med 7.1 vs 2.1%), p < 0.001 for trend and ESR (med 46 vs 23 mm/h, p = 0.03). Conclusions: Patients with RA were characterized by higher incidence of non-dipping pattern, SBPn elevation. Combination of high SBPn and non-dipping pattern was associated with higher CV risk. These associations may be mediated by inflammation. The publication was prepared with the support of the RUDN University Program 5-100.