Background/Purpose: Rheumatoid arthritis (RA) is associated with an increased incidence of cardiovascular disease. Hypertension is a major cardiovascular risk factor and it is one of the most common comorbid conditions in RA patients. The incidence and associated factors of hypertension occurring during the course of RA have not been extensively studied. Thus, we determined the demographic features, clinical manifestations, and pharmacologic profile associated with incident hypertension in a cohort of Hispanics with RA.

Methods: Hispanics from Puerto Rico with RA (per 1987 American College of Rheumatology classification criteria) were studied. Hypertension was defined as a blood pressure ≥140/90 mmHg on 2 or more subsequent visits. Incident hypertension was defined as that occurring after the onset of RA, whereas prevalent hypertension was defined as that occurring at or before the onset of RA symptoms. Demographic features, health-related behaviors, clinical manifestations, comorbidities, disease activity (per Disease Activity Score 28), functional status (per Health Assessment Questionnaire), patient’s and physician’s global disease assessments by visual analog scales, and pharmacologic treatment were determined. Differences between patients with incident hypertension and those without hypertension were examined by bivariable (chi-square and Student t tests) and multivariable (logistic regression) analyses.

Results: The entire cohort consisted of 405 RA patients. Prevalent hypertension was present in 83 (20.5%), incident hypertension in 140 (34.6%), and 182 (44.9%) patients did not have hypertension. The mean age of the study population was 54.4 years; 88.2% were women. The mean disease duration was 16.8 years. In the multivariable analysis adjusted for age, gender, disease duration, body mass index, dyslipidemia, and type 2 diabetes mellitus, incident hypertension was associated with joint replacement (OR 3.16, 95% CI 1.46-6.85, p=0.003), presence of fibromyalgia (OR 5.99, 95% CI 1.98-18.16, p=0.002), and corticosteroid use (OR 2.70, 95% CI 1.34-5.46, p=0.006). Conversely, exercise was negatively associated with incident hypertension (OR 0.41, 95% CI 0.19-0.88, p=0.023). No associations were observed for smoking, alcohol use, joint deformities, extra-articular manifestations, disease activity, functional status, patient’s or physician’s global disease assessments, early therapy (within 6 months of disease onset), or exposure to nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, or biologic agents.

Conclusion: In this population of patients, nearly 35% developed hypertension during the course of RA. Several features including joint replacement, presence of fibromyalgia, and corticosteroid use were associated with incident hypertension, whereas exercise was associated with decreased risk. Clinicians should be aware of these associations to provide appropriate management and counseling to RA patients, especially those related to modifiable factors such as exercise and steroid use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incident-hypertension-and-associated-factors-in-a-hispanic-group-with-rheumatoid-arthritis/