• Asso F. Amin Department of Medicine, School of Medicine Faculty of medical sciences, University of Sulaimani, Kurdistan Region, Iraq.
  • Raof Merza Department of Medicine, School of Medicine Faculty of medical sciences, University of Sulaimani, Kurdistan Region, Iraq.
  • Kosar Muhammed Department of Medicine, School of Medicine Faculty of medical sciences, University of Sulaimani, Kurdistan Region, Iraq.
  • Bahra Omer General Medical Teaching Hospital (Shaheed Hemn), Sulaimani Directorate of Health, Sulaimani, Kurdistan Region, Iraq.



Rheumatoid arthritis, Ambulatory blood pressure measurement



Rheumatoid Arthritis associates with excessive morbidity and mortality from cardiovascular events. Hypertension is considered as a major risk factor for development of cardiovascular disease. Insufficient control of blood pressure appears to be more in Rheumatoid arthritis. However, factors influence the control of blood pressure in rheumatoid arthritis is understudied.


To determine the control of blood pressure in rheumatoid arthritis versus non rheumatoid arthritis hypertensive subjects by using ambulatory blood pressure measurement and to identify the factors associated with insufficient control of blood pressure in Rheumatoid arthritis patients.

Patients and Methods

This is a case control study performed on seventy eight patients, 40 Rheumatoid arthritis hypertensive patient and 38 non-Rheumatoid arthritis hypertensive candidates between September 2012 and March 2013. Participants were between 45 and 85 years. An ambulatory blood pressure measurement was carried out for

all patients and an abnormal blood pressure was defined as systolic of more than 140 mm Hg and or diastolic of more than 90mm Hg.


Blood pressure control is significantly lower in rheumatoid arthritis hypertensive patients compared to hypertensive non Rheumatoid arthritis control subjects (p-value 0.034). Furthermore, steroid users had more insufficient control of blood pressure compared to non users (p-value 0.028).There was significant association

between methotrexate use and better control of hypertension (p-value 0.008).


The present study concludes that blood pressure control is lower in rheumatoid arthritis patients compared with non rheumatoid arthritis subjects; this may be of importance in the context of the increased cardiovascular morbidity and mortality. Those with co morbidity may require closer monitoring and treatment strategies.


Panoulas VF, Milionis HJ, Douglas KM . Association of serum uric acid with cardiovascular disease in rheumatoid arthritis. Rheumatology 2007; 46:1466–70. DOI:

Panoulas V.F, Metsios G.S, Pace A.V, John H, Treharne G.J, Banks M.J, Kitas G.D.Hypertension in rheumatoid arthritis. Rheumatology 2008 ;47:1286-1298. DOI:

Yusuf S, Hawken S, Ounpuu Sl. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study):Case-control study. Lancet 2004; 364:937–52. DOI:

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217–23. DOI:

Gonzalez A, Maradit KH, Crowson CS. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non rheumatoid arthritis patients? Ann Rheum Dis 2008 ;67:64–9. DOI:

Del.Rincon I, Freeman GL, Haas RW, O’Leary DH, Escalante A. Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis. Arthritis Rheum 2005; 52:3413–23. DOI:

Solomon DH, Curhan GC, Rimm EB, Cannuscio CC, Karlson EW. Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum 2004 ; 50:3444-9. DOI:

Luepker RV, Arnett DK, Jacobs DR . Trends in blood pressure, hypertension control, and stroke mortality: the Minnesota Heart Survey. Am J Med 2006; 119:42–9. DOI:

Primatesta P, Poulter NR. Improvement in hypertension management in England: results from the health survey for England 2003. Journal Hypertension 2006 ; 24:1187–92. DOI:

Duprez DA, Somasundaram PE, Sigurdsson G, Hoke L, Florea N, Cohn JN. Relationship between C-reactive protein and arterial stiffness in an asymptomatic population. J Hum Hypertension 2005; 19:515–9. DOI:

Munneke M, de Jong Z, Zwinderman AH. High intensity exercise or conventional exercise for patients with rheumatoid arthritis? Outcome expectations of patients, rheumatologists, and physiotherapists. Ann Rheum Dis 2004 ;63:804–8. DOI:

Morrison A, Ramey DR, van Adelsberg J, Watson DJ. Systematic review of trials of the effect of continued use of oral non-selective NSAIDs on blood pressure and hypertension. Curr Med Res Opin 2007 ; 23:2395–404. DOI:

Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham Heart Study.Circulation 1999; 100:354–60. DOI:

Rozman B, Praprotnik S, Logar D et al. Leflunomide and hypertension. Ann Rheum Dis 2002; 61:567–9. DOI:

Weinblatt ME, Coblyn JS, Fraser PA. Cyclosporin A treatment of refractory rheumatoid arthritis. Arthritis Rheum 1987; 30:11–7. DOI:

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24. DOI:

Williams B, Poulter NR, Brown MJ. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004;18:139–85. DOI:

Buttgereit F, da Silva JA, Boers M et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61:718–22. DOI:

Vangestelam AM, Haagsma CJ, Vanrieil C M: Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 1998; 41: 1845-50. DOI:<1845::AID-ART17>3.0.CO;2-K

O’Brien E, Coats A, Owens P, Petrie J, Padheld P, Littler WA. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 2000;320:1128-34. DOI:

Prospective Studies Collaboration: age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2006;360:1903–13. DOI:

Nurmohamed MT. Cardiovascular risk in rheumatoid arthritis. Autoimmun Rev 2009;8:663–7. DOI:

Kitas GD, Erb N. Tackling Ischemic heart disease in rheumatoid arthritis. Rheumatology 2003;42:607-13. DOI:

Stevens RJ, Douglas KMJ, Saratzis AN, Kitas GD. Inflammation and atherosclerosis in rheumatoid arthritis. Exp Rev Mol Med 2005; 7:1-24. DOI:

Jackson SH, Beevers DG,Myers K,.Does long- term low-dose corticosteroid therapy cause hypertension?.Clin Sci(Lond) 1981;61 Suppl 7-381s-3. DOI:

Stavropoulos-Karlinoglou A, Metsios GS, Koutedakis Y. Redefining overweight and obesity in rheumatoid arthritis patients. Ann Rheum Dis 2007, doi:10.1136/ard.2006. DOI:

Krause D, Schleusser B, Herborn G, Rau R. Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis. Arthritis Rheum 2000; 43(1): 14-21. DOI:<14::AID-ANR3>3.0.CO;2-7






How to Cite

Amin A, Merza R, Muhammed K, Omer B. THE IMPLICATION OF RHEUMATOID ARTHRITIS ON BLOOD PRESSURE CONTROL. JSMC [Internet]. 2015 Jun. 1 [cited 2024 Jun. 13];5(1):7-15. Available from:

Similar Articles

1-10 of 117

You may also start an advanced similarity search for this article.