THE IMPLICATION OF RHEUMATOID ARTHRITIS ON BLOOD PRESSURE CONTROL
DOI:
https://doi.org/10.17656/jsmc.10062Keywords:
Rheumatoid arthritis, Ambulatory blood pressure measurementAbstract
Background
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.
Objectives
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.
Results
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).
Conclusion
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.
References
Panoulas VF, Milionis HJ, Douglas KM . Association of serum uric acid with cardiovascular disease in rheumatoid arthritis. Rheumatology 2007; 46:1466–70. DOI: https://doi.org/10.1093/rheumatology/kem159
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: https://doi.org/10.1093/rheumatology/ken159
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: https://doi.org/10.1016/S0140-6736(04)17018-9
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: https://doi.org/10.1016/S0140-6736(05)17741-1
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: https://doi.org/10.1136/ard.2006.059980
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: https://doi.org/10.1002/art.21397
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: https://doi.org/10.1002/art.20636
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: https://doi.org/10.1016/j.amjmed.2005.08.051
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: https://doi.org/10.1097/01.hjh.0000226210.95936.bc
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: https://doi.org/10.1038/sj.jhh.1001860
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: https://doi.org/10.1136/ard.2003.011189
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: https://doi.org/10.1185/030079907X219553
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: https://doi.org/10.1161/01.CIR.100.4.354
Rozman B, Praprotnik S, Logar D et al. Leflunomide and hypertension. Ann Rheum Dis 2002; 61:567–9. DOI: https://doi.org/10.1136/ard.61.6.567
Weinblatt ME, Coblyn JS, Fraser PA. Cyclosporin A treatment of refractory rheumatoid arthritis. Arthritis Rheum 1987; 30:11–7. DOI: https://doi.org/10.1002/art.1780300102
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: https://doi.org/10.1002/art.1780310302
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: https://doi.org/10.1038/sj.jhh.1001683
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: https://doi.org/10.1136/ard.61.8.718
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: https://doi.org/10.1002/1529-0131(199810)41:10<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: https://doi.org/10.1136/bmj.320.7242.1128
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: https://doi.org/10.1016/S0140-6736(02)11911-8
Nurmohamed MT. Cardiovascular risk in rheumatoid arthritis. Autoimmun Rev 2009;8:663–7. DOI: https://doi.org/10.1016/j.autrev.2009.02.015
Kitas GD, Erb N. Tackling Ischemic heart disease in rheumatoid arthritis. Rheumatology 2003;42:607-13. DOI: https://doi.org/10.1093/rheumatology/keg175
Stevens RJ, Douglas KMJ, Saratzis AN, Kitas GD. Inflammation and atherosclerosis in rheumatoid arthritis. Exp Rev Mol Med 2005; 7:1-24. DOI: https://doi.org/10.1017/S1462399405009154
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: https://doi.org/10.1042/cs061381s
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: https://doi.org/10.1136/ard.2006.060319
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: https://doi.org/10.1002/1529-0131(200001)43:1<14::AID-ANR3>3.0.CO;2-7
Downloads
Published
Issue
Section
License
Copyright (c) 2015 Asso F. Amin, Raof Merza, Kosar Muhammed, Bahra Omer
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.