Hypertension common, predicted by older age, diabetes in early rheumatoid arthritis
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Key takeaways:
- One-quarter of non-hypertensive patients with early RA developed hypertension during a median 5 years of follow-up.
- Traditional CV risk factors were at play, including older age and being overweight.
Hypertension is common in patients with early rheumatoid arthritis, and most frequently develops in older patients and those with traditional cardiovascular risk factors, according to data published in Rheumatology Advances in Practice.
“Compared with the general population, RA patients are 50% to 60% more likely to experience cardiovascular events and cardiovascular death,” Brook Hadwen, MS, a PhD student in kinesiology at the University of British Columbia, and colleagues wrote. “These events appear to occur later in the RA disease course, thus there may be a window of opportunity to identify and modify cardiovascular risk factors in early RA and prevent future complications. Unfortunately, there is a lack of studies investigating the incidence of hypertension and factors associated with incident hypertension in early RA patients.”
To explore factors associated with hypertension in early RA, Hadwen and colleagues analyzed data on 2,052 patients (mean age, 55 years; 71% women) from the Canadian Early Arthritis Cohort study. Using multivariable logistic regression, the researchers examined the initial prevalence of hypertension and explored its subsequent development among those without hypertension at baseline. The researchers defined baseline hypertension using physician reports, medication history or patient survey. They additionally monitored blood pressure measurements during follow-up.
At baseline, 26% (n = 537) of study participants were already diagnosed with hypertension, including 34% of men and 23% of women. In both sexes, this was more likely if they were aged 50 years or older (OR = 4.83; 95% CI, 3.18-7.34), or had diabetes (OR = 3.52; 95% CI, 2.29-5.42) or hyperlipidemia (OR = 2.49; 95% CI, 1.79-3.46), according to the researchers. Among women, baseline hypertension was also associated with high alcohol consumption (OR = 2.91; 95% CI, 1.15-7.36) and being overweight (OR vs. normal BMI = 1.83; 95% CI, 1.17-2.85).
Among participants without hypertension at baseline, 24% developed hypertension over a median follow-up period of 5 years, according to the researchers. In both sexes, incident hypertension was predicted by older age (OR = 2.46; 95% CI, 1.73-3.51), being overweight (OR = 1.95; 95% CI, 1.33-2.85) or obese (OR = 3.52; 95% CI, 2.36-5.24), and having hyperlipidemia (OR = 1.69; 95% CI, 1.07-2.66). It was particularly likely with high alcohol consumption among men (OR = 4.39; 95% CI, 1.5-12.87) and hyperlipidemia among women (OR = 2.17; 95% CI, 1.18-4.02).
“In Canadian early RA patients, hypertension prevalence at RA onset appears to be similar to that of the general population,” Hadwen and colleagues wrote. “After RA diagnosis, patients have a high risk of developing new hypertension. Characteristics associated with hypertension in RA patients (older age, diabetes, high BMI, dyslipidemia and excessive alcohol intake) were also consistent with those of the general population.
“Given the high frequency of cardiovascular risk factors in RA, patients should be routinely screened and modifiable risk factors managed,” they added. “Future research should explore risk factors for hypertension beyond RA diagnosis, as factors contributing to the risk of hypertension and cardiovascular events may change as RA disease progresses.”
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