HYPERTENSIVE PATIENTS WITH RHEUMATOID ARTHRITIS ARE CHARACTERIZED BY HIGHER LEVELS OF THE OFFICE BLOOD PRESSURE AND WORSE CONTROL OF CENTRAL BLOOD PRESSURE COMPARED TO THE CONTROLS

Abstract

Objective: Rheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk. Arterial hypertension (HTN) is an important modifiable CVD risk factor. Its prevalence and significance in RA is still a matter of investigation. The aim of the study was to evaluate the office peripheral and central BP levels in patients with RA compared to the control group. Design and method: The study group included 85 patients without known CVD (77.6% females, age 59.7 ± 14.3 (M ± SD) years, 65% with HTN, median duration of HTN 6.6 years. Median duration of RA was 7 years, seropositive RA was diagnosed in 65%. Median hsCRP was 10 mg/dl, median rheumatoid factor – 51.3 IU/ml, mean DAS-28(CRP)-3.7 ± 1.1. All received disease-modifying anti-rheumatic drugs. The control group included 40 patients matched by basic parameters (77.5% females, age 58.9 ± 15.5 years, 60% with HTN, median duration of HTN 5 years). All patients with HTN received antihypertensive therapy. Office peripheral BP was measured with a validated oscillometric device, office central BP (CBP)–with applanation tonometry. CBP elevation was assessed according to individual reference values by gender and age. p < 0.05 was considered significant. Results: The rate of BP control in hypertensive patients was 58% in RA and 67% in the control group (χ2 = 0.5, p = 0.48). In patients without HTN mean office peripheral and central BP levels were similar in the RA and the control groups: 117 ± 13/73 ± 9 vs 117 ± 7/68 ± 8 mmHg and 108 ± 13/74 ± 10 mmHg vs 106 ± 10/71 ± 8 mmHg respectively (p > 0.05 for the trend). In patients with HTN corresponding BP levels were the following: 138 ± 17/82 ± 10 vs 130 ± 16/74 ± 11 mmHg (p = 0.04 for SBP; p = 0.0003 for DBP) and 132 ± 20/82 ± 10 vs 120 ± 17/74 ± 12 mmHg (p = 0.01 for SBP; p = 0.001 for DBP). The elevation of CBP was observed in 42.4% of RA patients and 17.5% of the controls (χ2 = 14.9, p = 0.0001): 16.7% vs 0% in the group without HTN (χ2 = 6.0, p = 0.01) and 56.4% vs 29.2% in the HTN group (χ2 = 9.9, p = 0.002), respectively. Conclusions: Despite similar BP control patients with RA are characterized by higher levels of office peripheral and central BP compared to the control group. RA is associated with worse control of central BP.