ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 682

Nonsteroidal Anti-Inflammatory Drug Use and Hypertension in Ankylosing Spondylitis

Jean Liew1, John D. Reveille2, Michael Ward3, MinJae Lee4, Matthew Brown5, Mohammad H. Rahbar6, Michael Weisman7 and Lianne S. Gensler8, 1Internal Medicine; Division of Rheumatology, University of Washington, Seattle, WA, 2Rheumatology, McGovern Medical School at the University of Texas Health Science Center at Houston, USA, Houston, TX, 3National Institutes of Health, Bethesda, MD, USA, Bethesda, MD, 4Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, University of Texas-McGovern Medical School, Houston, TX, 5Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia, Brisbane, Australia, 6Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, USA, Houston, TX, 7Cedars-Sinai Medical Center, Los Angeles, CA, USA, Los Angeles, CA, 8University of California San Francisco, San Francisco, CA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Date: Sunday, October 21, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Imaging, Clinical Studies, and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Cardiovascular morbidity and mortality are increased in Ankylosing Spondylitis (AS). Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line pharmacological therapy in AS; however, their propensity to increase blood pressure and potentially increase cardiovascular burden may limit their long-term use in an already at-risk population. Our objective was to determine the association of NSAID use and hypertension in AS.

Methods: We included 1069 adults with AS meeting the modified New York criteria from a longitudinal cohort with available NSAID and antihypertensive medication use data. Hypertension was defined by antihypertensive medication use. NSAID use was defined by the validated NSAID index and categorized according to no use or low vs. high NSAID use (index < 50 vs. ≥50). We conducted a comparison of baseline characteristics for patients with and without hypertension, using a chi-square test for categorical variables and Student’s t-test or its nonparametric counterpart, as appropriate, for continuous variables. We assessed the association between NSAID use and hypertension at baseline with a multivariable logistic regression analysis.

Results: At baseline, the cohort was 74.1% male, 80.4% white, with a mean age 43.2 ± 14.2 years, and median disease duration of 16.0 years (interquartile range (IQR) = [8,27]) (Table 1). At baseline, 22.8% of patients had hypertension. After adjustment for age, gender and other covariates, the multivariable results found high compared to low dose NSAID use (adjusted OR 2.1, 95%CI 1.1-3.8) was associated with hypertension at baseline.

Conclusion: Compared to AS patients without hypertension, those with hypertension were significantly older, had longer disease duration, and more cardiovascular disease. Although there was no significant difference between any NSAID use versus no use, the multivariable analysis found a significant association between hypertension and high compared to low NSAID use. These data suggest a relationship between NSAID use and comorbid hypertension in AS, which may be dose-dependent and conditional upon the decision to initiate treatment.

Table 1 –Baseline characteristics of patients with and without hypertension

Variables

All patients

N=1069

Hypertension (-)

n=825 (77.2%)

Hypertension (+)

n = 244 (22.8%)

p value

Baseline NSAID index with 3 categories:

0.0001

NSAID index=0, %

365 (34.1)

266 (32.2)

99 (40.6)

0< NSAID index <50, %

337 (31.5)

287 (34.8)

50 (20.5)

NSAID index≥50%

367 (34.3)

272 (33.0)

38 (38.9)

Male gender, %

792 (74.1)

593 (71.9)

199 (81.6)

0.002

Age, mean±SD

43.24 (14.2)

39.50 (12.5)

55.9 (12.0)

<0.0001

White race, %

859 (80.4)

647 (78.4)

212 (86.9)

0.004

Education beyond high school, %

857 (81.4)

657 (80.8)

200 (83.3)

0.4

Disabled, %

81 (7.6)

49 (5.9)

32 (13.1)

0.0002

HLA-B27 positive, %

872 (83.0)

675 (83.3)

197 (81.7)

0.6

Disease duration (years), med (IQR)

16.0 (8.0, 27.0)

13.0 (6.0, 22.0)

29.0 (20.0, 39.0)

<0.0001

BASDAI (0-10), med (IQR)

3.6 (1.8, 5.9)

3.6 (1.6, 5.7)

3.9 (2.2, 6.2)

0.01

CRP (mg/dl), med (IQR)

0.4 (0.2, 1.1)

0.5 (0.2, 1.1)

0.4 (0.2, 0.9)

0.7

ESR (mm/hr), med (IQR)

11.0 (5.0, 22.0)

11.0 (5.0, 23.0)

11.0 (6.0, 20.0)

0.5

Analgesic use, %

290 (27.1)

196 (23.8)

94 (38.5)

<.0001

Ever smoker, %

468 (44.8)

332 (41.2)

136 (56.9)

<.0001

Cardiovascular disease, %

86 (8.2)

32 (4.0)

54 (22.4)

<.0001

TNFi use, %

440 (41.2)

328 (39.8)

112 (45.9)

0.09

med: median; IQR: interquartile range

Table 2 – Multivariable analysis – Factors associated with hypertension at baseline

Variables

Adjusted Odds Ratio (95% CI)

p value

Baseline NSAID index with 3 categories

0.05

Low vs. no use

0.7 (0.4, 1.3)

0.3

High vs. no use

1.5 (0.9, 2.4)

0.1

High vs. low

2.1 (1.1, 3.8)

0.02

Male vs. female

1.3 (0.7, 2.2)

0.5

Age (year):

<.0001

35-49 vs. ≤34

2.8 (1.3, 6.1)

0.01

≥50 vs. ≤34

9.2 (4.1, 21.0)

<.0001

Cardiovascular disease vs. no cardiovascular disease

4.3 (2.2, 8.5)

<.0001

Variables adjusted in this model included age, gender, race, education, disease duration, BASDAI, disability, CRP, mSASSS, TNFi use, and cardiovascular disease.

Disclosure: J. Liew, None; J. D. Reveille, Janssen, 5,Eli Lilly and Co., 2, 5,UCB, Inc., 5,Novartis, 5; M. Ward, None; M. Lee, None; M. Brown, None; M. H. Rahbar, None; M. Weisman, GSK, Lilly, Novartis, Baylx, Celltrion. All are consulting fees, 5, 6; L. S. Gensler, AbbVie Inc., 2,Amgen Inc., 2,Novartis, 2, 5,UCB, Inc., 2,Galapagos, 5,Janssen, 5,Eli Lilly and Co., 5,Pfizer, Inc., 5.

To cite this abstract in AMA style:

Liew J, Reveille JD, Ward M, Lee M, Brown M, Rahbar MH, Weisman M, Gensler LS. Nonsteroidal Anti-Inflammatory Drug Use and Hypertension in Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/nonsteroidal-anti-inflammatory-drug-use-and-hypertension-in-ankylosing-spondylitis/. Accessed .

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