Hypertension In Rheumatoid Arthritis Research Articles

Risk factors for prevalent and incident hypertension in rheumatoid arthritis: data from the Canadian Early Arthritis Cohort.

Hypertension (HTN) is a common comorbidity in RA. This study aimed to explore the prevalence and incidence of HTN and baseline factors associated with incident HTN in early RA (ERA). Data were from the Canadian Early Arthritis Cohort (CATCH), an inception cohort of ERA patients having <1 year of disease duration. HTN was determined by patient- or physician-reported diagnosis, the use of anti-hypertensives and/or blood pressure. Multivariable logistic regression was performed to determine baseline factors associated with prevalent and incident HTN in this population. The study sample included 2052 ERA patients [mean age 55 years (s.d. 14), 71% female). The prevalence of HTN at study enrolment was 26% (23% in females and 34% in males). In both sexes, prevalent HTN was associated with older age, diabetes and hyperlipidaemia. HTN was associated with being overweight or high alcohol consumption in females. Of the RA patients who did not have HTN at enrolment, 24% (364/1518) developed HTN during the median follow-up period of 5 years (range 1-8). Baseline factors significantly associated with incident HTN were older age, being overweight, excess alcohol consumption and having hyperlipidaemia. Incident HTN was associated with high alcohol consumption in males and with hyperlipidaemia in females. RA-associated disease factors and treatments were not significantly associated with prevalent or incident HTN. Early RA patients had a high incidence of hypertension with the highest risk in older patients with traditional cardiovascular risk factors.

Risk factors for hypertension in rheumatoid arthritis patients-A systematic review.

Rheumatoid arthritis is frequently associated with hypertension, which has been shown to increase the risk of cardiovascular disease in these patients. The aim of this systematic review was to explore demographic, behavioural or clinical factors including medication use, associated with incident hypertension in rheumatoid arthritis. MEDLINE and Scopus were searched for eligible studies that longitudinally investigated incident hypertension or changes in blood pressure (BP) in rheumatoid arthritis patients. Publications were screened by two reviewers according to predetermined inclusion and exclusion criteria. The quality of included studies was assessed via the Newcastle Ottawa Scale and Cochrane Risk of Bias Tool. Fourteen studies were deemed eligible and included in this review. The proportion of female subjects ranged from 12 to 87% and the mean age ranged from 47 to 61years. Regular exercise was associated with a decrease in systolic BP, p=0.021. Methotrexate was associated with decreased risk of hypertension in two studies. LEF was associated with increased BP in two studies. COX-2 inhibitors were associated with systolic BP and diastolic BP variability (p=0.009, 0.039, respectively) in one study. Prednisone was found to increase BP and risk of hypertension in three studies. The risk of hypertension in patients taking biologic disease modifying anti-rheumatic drugs (DMARDs) is unclear as some studies report increased BP while others report no difference for biologic compared to conventional DMARDs. Despite limited longitudinal studies exploring this topic, methotrexate and exercise were shown to protect against risk of hypertension in RA patients, while prednisone and COX-2 inhibitors may increase risk of hypertension.

P4444Hypertension, autoimmune inflammation and salt sensitivity in women with rheumatoid arthritis

Abstract Introduction Hypertension (HTN) takes the first place among cardiovascular diseases in patients with rheumatoid arthritis (RA). Currently, the main risk factors for hypertension are known, but eating habits are often not considered in patients with RA. The salt taste sensitivity threshold (STST) in women with autoimmune inflammation and the effect of salt sensitivity to hypertension in RA have not been practically studied which was the novelty of our study. Purpose Purpose is to determine the salt taste sensitivity threshold in women with RA and assess the correlation between salt sensitivity, autoimmune inflammation and the development of hypertension in women with RA. Methods STST was studied in all patients with RA (n=202). Then, to assess the risk factors for hypertension in RA, the patients were divided into 2 groups: group 1 – patients with hypertension (n=141), group 2 – patients without hypertension (n=61). The patients' examination was carried out using the standards of the Association of Rheumatologists of Russia and the Russian Society of Cardiology. Salt taste sensitivity threshold was determined with R.J. Henkin's method. The patients with middle and high STST were considered salt-sensitive. Statistical data were obtained with Statistica 10.0. Regression analysis was used to identify the correlation between risk factors and the development of hypertension. Results The following results based on STST testing were obtained in patients with RA (n=202): high STST was in 129 patients (64.3%), middle - in 20 patients (10.7%), low - in 53 patients (25.0%). The activity of the inflammatory process was significantly higher in salt-sensitive patients (p=0.01). According to regression analysis, the predictors for hypertension in women with RA, in order of importance were age &gt;55 years (p=0.001), early menopause (p=0.001), increased total cholesterol (p=0.001), taking prednisolone &gt;10 mg/day (p=0.001), early family history of cardiovascular diseases (p=0.01), reduced glomerular filtration rate &lt;60 ml/min 1.73 m2 (p=0.01), high STST (p=0.01), pregnancy pathology (p=0.01), high activity of the inflammatory process (p=0.01), psychosocial factors (stress, anxiety, depression) (p=0.01), obesity (p=0.01), RA duration &gt;10 years (p=0.01). There were twice as many salt-sensitive patients with RA and HTN as with RA and without HTN (87% and 48%, respectively). Excessive fluid in the body was observed with decreased natriuresis that assumes the presence of volume-dependent hypertension. Conclusion The results of the study showed the importance to determine STST associated with a set of factors and autoimmune inflammation was significant among them. The widespread application of the method determining the salt sensitivity will make it possible to increase the effectiveness of hypertension treatment based on individual recommendations for women with RA.

Impaired renal functions in Pakistani cohort of rheumatoid arthritis.

Objective:To determine the frequency of impaired renal functions and hypertension in rheumatoid arthritis.Methods:This study was conducted between May 1st 2018 to February 1st 2019 at Rheumatology Division, Department of Medicine Central Park Medical College Lahore, total 260 study participants were selected, demographic detail were asked in detail, disease duration of RA and hypertension, DMARD’s, self-use NSAID’s,/hakeem medications, smoking were asked in detail, BMI and blood pressure were measured,5 ml of blood was taken by trained phlebotomist, and sent for the estimation of serum urea and creatinine on (COBAS-III) machine, after availability of results each individuals eGFR (creatinine clearance) was calculated by Cockroft Gualt(CG) and Modification in diet in renal disease method (MDRD).Results:In this study the mean age of study participants was 42.4 (± 9.5) years with disease duration of 7.7(±4.8) years, prevalence of Impaired renal functions of 14.6% (n=38) and hypertension in 53.5% (n=139).Regression analysis shows there is significant association between hypertension, smoking and self/hakeem medications with impaired renal functions (p-0.5). Kappa analysis shows both (MDRD & CG methods) had uniformity in picking up cases of impaired renal functions 75.6% (p-0.05).Conclusion:In RA decline in renal functions is seen with self-use NSAID’s/hakeem medications along with other modifiable factors like smoking and hypertension, while conventional DMARD’s don’t show association with decline. There is very high prevalence of hypertension in rheumatoid arthritis.

Association between urinary sodium and potassium excretion and blood pressure and inflammation in patients with rheumatoid arthritis.

Hypertension is highly prevalent in patients with rheumatoid arthritis (RA). In other populations, high sodium (Na+) and low potassium (K+) intake are associated with an increased risk of hypertension, and in animal models, a high salt intake exacerbated arthritis. Patients with RA have many comorbidities associated with salt sensitivity, but their salt intake and its relationship to blood pressure and inflammation is unknown. Using the Kawasaki formula, Na+ and K+ urinary excretion (reflecting intake) was estimated in 166 patients with RA and 92 controls, frequency matched for age, sex, and race. Inflammatory markers and disease activity were measured in RA patients. We tested the associations between blood pressure and Na+ and K+ excretion. Estimated 24-h Na+ excretion was similarly high in both RA (median [IQR] 5.1g, [3.9-6.6g]) and controls (4.9g, [4.0-6.5g]), p = 0.9, despite higher rates of hypertension in RA (54 vs. 39%, p = 0.03). The Na+:K+ excretion ratio was significantly higher in RA (2.0 [1.6-2.4]) vs. 1.7 [1.5-2.1]), p = 0.02] compared to controls. In RA, a lower K+ excretion was inversely correlated with diastolic blood pressure (adjusted β = - 1.79, p = 0.04). There was no significant association between Na+ or K+ excretion and inflammatory markers. Despite a similar Na+ excretion, patients with RA had higher rates of hypertension than controls, a finding compatible with increased salt sensitivity. Patients with RA had a lower Na+:K+ excretion ratio than controls, and lower K+ excretion was associated with higher diastolic blood pressure in RA.

Inflammation and Hypertension in Rheumatoid Arthritis

Hypertension (HTN), a common modifiable cardiovascular risk factor, is more common in patients with rheumatoid arthritis (RA), but the underlying mechanisms are unclear. We examined the hypothesis that mediators of inflammation and markers of cardiovascular risk are associated with HTN in RA. We compared measures of inflammation [serum C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), homocysteine, and leptin concentrations] and insulin resistance [homeostasis model assessment index (HOMA)] in RA patients with (n = 90) and without HTN (n = 79). HTN was defined as blood pressure ≥ 140/90 mm Hg or treatment with antihypertensive therapy. The independent association of markers of interest with HTN was examined using multivariable logistic regression. Patients with HTN were significantly older and had longer disease duration than those without HTN (both p < 0.001). Concentrations of homocysteine [11.1 (8.5-13.5) μmol/l vs 9.3 (7.8-11.0) μmol/l] were significantly higher in patients with HTN (p < 0.001). After adjustment for age, sex, race, smoking, body mass index, and corticosteroid and nonsteroidal antiinflammatory drugs (NSAID) use, increased concentrations of homocysteine (OR 2.9, 95% CI: 1.5-5.5, p = 0.001), and leptin (OR 2.0, 95% CI: 1.0-3.8, p = 0.046) were significantly associated with HTN, but the 28-joint Disease Activity Score, IL-6, CRP, TNF-α, and HOMA index were not (all p > 0.05). HTN in patients with RA is not associated with generalized systemic inflammation or insulin resistance, but is associated with increasing concentrations of homocysteine and leptin. The pathogenesis of HTN in RA may involve pathways more regularly associated with fat and vascular homeostasis.

SAT0073 Arterial Hypertension In Rheumatoid Arthritis Without Cardiovascular Disease: High Prevalence, Low Awareness, Poor Control And Increased Vascular Damage-Associated “White Coat” Phenomenon

BackgroundRheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk, whereas the prevalence and significance of arterial hypertension, the major modifiable CVD risk factor, is still a matter...

OP0164 Long-Term Blood Pressure Variability in Patients with Rheumatoid Arthritis (RA) Vs General Population, and its Impact on Cardiovascular Events and All-Cause Mortality in RA

BackgroundErratic blood pressure (BP) has been linked to increased risk of cardiovascular (CV) events and death in the general population. The impact of BP variability on CV events and mortality...

Is the prevalence of arterial hypertension in rheumatoid arthritis and osteoarthritis associated with disease?

In this study, we compare the prevalence of arterial hypertension (HT) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, exposed to high- and low-grade chronic inflammation, respectively, to assess the possible association between chronic inflammation and HT. A total of consecutive 627 RA and 352 OA patients were enrolled in this multicentric study. HT was defined as a systolic blood pressure (BP) ≥ 140 and/or diastolic BP ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index (BMI) ≥ 25, and patients ≥65 years were considered elderly. The prevalence of HT was higher in the OA group than in the RA group [73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively]. When the results were adjusted for age and BMI, the HT prevalence was similar in both groups [RA 59 % (95 % CI, 55.1, 63.8) OA 60 % (95 % CI, 58.4, 65.0)]. In both groups, the prevalence of HT was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (BMI ≥ 25) and age ≥65 were independent predictors of HT in multivariate logistic regression model, which showed no association between HT and the disease (RA or OA). The results indicate a robust association of age and BMI with HT prevalence in both RA and OA. The difference in HT prevalence between RA and OA is due rather to age and BMI than to the features of the disease, putting into question specific association of HT with RA.

The prevalence and risk factors of arterial hypertension in rheumatoid arthritis

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Association of Mean Platelet Volume with Hypertension in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is one of the most common chronic inflammatory disorders associated with enhanced cardiovascular morbidity and mortality. Established high prevalence of classical cardiovascular risk factors may only partly explain cardiovascular phenomenon in this disease. Emerging risk factors, markers of inflammation and prothrombotic state such as platelet size are believed to reflect activity of RA. We aimed to study mean platelet volume (MPV) in a cohort of patients with RA and to clarify possible effects of classical cardiovascular and RA-associated risk factors on MPV. Demographic, clinical and a wide range of laboratory parameters, including MPV and platelet count, were obtained for 400 RA patients. Platelet size and count were also assessed in 360 non-RA controls from the local population. We found significantly increased MPV in RA patients compared with controls (P=0.001). The difference retained significant after adjustment for age and sex. High values of MPV (>or=10.7 femtoliter [fL]) were more frequent in RA patients than in controls (21% vs. 9.2%; P<0.0001). In RA patients, blood pressure greater than 140/90 mmHg was associated with high levels of MPV (Odds Ratio [OR] 2.2, 95% Confidence Interval [CI] 1.3-3.7; P=0.003). It is possible that MPV as a surrogate marker of platelet function reflects enhanced vascular risk. To further explore the role of MPV as a marker for cardiovascular risk in RA, prospective studies are warranted.

Transforming growth factor- 1 869T/C, but not interleukin-6 -174G/C, polymorphism associates with hypertension in rheumatoid arthritis

Part of the deleterious effects of systemic inflammation on the cardiovascular system of patients with RA may be exerted via increased propensity to hypertension. IL-6 and TGF-beta1 are important regulators of the inflammatory response. In some, but not all, studies, IL6 -174G/C (rs1800795) and TGFB1 869T/C (rs1982073) gene polymorphisms have been associated with hypertension in the general population. The present study addressed their potential association with hypertension in RA patients. TGFB1 869T/C and IL6 -174G/C were identified in 400 RA patients and 422 local, non-RA controls using real-time PCR and melting curve analysis. Binary logistic and linear regression models were used to identify the independence of the effects of the polymorphisms on hypertension. Genotypic and allelic frequencies of the two polymorphisms were similar in RA and controls. Within the RA group, there was no significant association between IL6 -174G/C and hypertension, but TGF 869T-allele carriers had significantly increased prevalence of hypertension compared with CC homozygotes (70.2 vs 55.2%; P = 0.023). This association remained significant after adjustment for other hypertension risk factors and medication (odds ratio = 1.96; 95% CI 1.02, 3.77; P = 0.044), and was more pronounced in patients with increased systemic inflammation. This study suggests an association of TGFB1 869T/C, but not of IL6 -174G/C, with hypertension in RA patients. If this finding is confirmed in prospective studies, this polymorphism could be used as a screening tool for RA patients with higher risk of developing hypertension and lead to increased surveillance and earlier treatment.

Factors That Impact Decision Making Among Rheumatologists in the Initiation of Treatment for Hypertension in Rheumatoid Arthritis

Increased risks of morbidity and mortality from cardiovascular (CV) events are reported in patients with rheumatoid arthritis (RA). Recent reviews recommend aggressive treatment of modifiable CV risk factors, including systemic hypertension (HTN). We examined possible contributory factors influencing HTN treatment among RA patients by rheumatologists. We conducted a cross-sectional 36-item survey of randomly chosen rheumatologists from the American College of Rheumatology directory collecting the rheumatologists' demographics, practice, and perceptions regarding HTN treatment in their RA patients. Our response variable was initiation of HTN treatment. Independent variables were derived from responses to the survey, and data were analyzed using bivariate analysis and logistic regression. Of 938 rheumatologists surveyed, 285 (30%) responded, 236 were subsequently analyzed. Respondents' mean age was 52.8 years; 75% were male and most were white (83%). Respondents reported routinely screening for HTN (92.8%), and initiating treatment for HTN (31%) in RA patients. Rheumatologists who believed that their RA patients did not have adequate visits with their primary care providers (PCP) were 2.2 times as likely to initiate treatment for HTN (41.1% vs. 24.3%; P = 0.006). Conversely, 33% of rheumatologists who did not routinely initiate treatment for HTN in their RA patients also did not believe patient access to PCP care was adequate. No associations were observed between initiation of HTN treatment and physician demographic or practice items. The need for more effective minimization of CV risks in RA patients should prompt rheumatologists to consider a revision of routine practice standards to include treatment of uncontrolled HTN or promotion of improved communication with their PCPs.

Serum uric acid is independently associated with hypertension in patients with rheumatoid arthritis

Hypertension (HT) is highly prevalent in rheumatoid arthritis (RA). Serum uric acid (SUA) has been associated with HT in the general population. The mutual exclusion of gout and RA, and the systemic inflammatory component of RA may alter this association in this patient population. We explored a potential association between SUA levels and HT in RA and evaluated whether this association is independent of HT risk factors, RA characteristics and relevant drugs. A total of 400 consecutive RA patients were assessed. SUA and complete biochemical profile were measured. Demographic, HT-related factors, RA characteristics and drugs were assessed as potential covariates. Results were analysed using binary logistic models to test the independence of the association between SUA and HT. SUA levels were higher in hypertensive compared to normotensive RA patients (5.44+/-1.6 mg dl(-1) (323.57+/-95.17 micromol l(-1)) vs 4.56+/-1.1 mg dl(-1) (271.23+/-65.43 micromol l(-1)), P<0.001). When adjusted for HT risk factors, renal function, RA characteristics, non-steroidal anti-inflammatory drugs, oral prednisolone, cyclosporine, leflunomide and low-dose aspirin, the odds of being a hypertensive RA patient per 1 mg dl(-1)(59.48 micromol l(-1)) SUA increase were significantly increased: OR=1.59 (95% CI: 1.21-2.1, P=0.001). This was also significant for the subgroup of patients who were not on diuretics (OR=1.5, 95% CI: 1.1-2.05; P=0.011). This cross-sectional study suggests that SUA levels are independently associated with HT in RA patients. Prospective longitudinal studies are needed to confirm and further explore the causes and implications of this association.

Pulmonary hypertension in rheumatoid arthritis — Relation with the duration of the disease

Isolated pulmonary hypertension with clinical implication is rare in rheumatoid arthritis. We sought to study the prevalence of pulmonary arterial hypertension in an unselected population of 45 patients with rheumatoid arthritis (classified according to the ARA criteria) without cardiac disease and corresponding age and sex matched controls by Doppler echocardiography. The pulmonary artery systolic pressure was higher in patients with Rheumatoid Arthritis (27.49 ± 12.66 mm Hg) than in controls (20.40 ± 8.88) ( p = 0.003). Incidence of pulmonary artery systolic pressure > 30 mm Hg suggesting pulmonary hypertension was significantly higher in patients with RA (26.7% versus 4.5% in controls; p = 0.03) and 20% of patients had pulmonary hypertension without lung disease or cardiac disease evident on pulmonary function testing, and echocardiogram respectively. There was also a strong correlation between the pulmonary artery pressure and the disease duration ( r = 0.68, p < 0.0001) suggesting a subclinical involvement of the pulmonary vasculature with disease progression and may be relevant to the high incidence of cardiovascular deaths observed in patients with Rheumatoid Arthritis.

Cardiovascular remodeling and arterial hypertension in rheumatoid arthritis: Predisposing conditions and risk factors

Cardiovascular remodeling and arterial hypertension in rheumatoid arthritis: Predisposing conditions and risk factors

Pulmonary Hypertension in Rheumatoid Arthritis: Report of a Case with Intimal Sclerosis of the Pulmonary and Digital Arteries

Pulmonary Hypertension in Rheumatoid Arthritis: Report of a Case with Intimal Sclerosis of the Pulmonary and Digital Arteries