Session Information
Date: Sunday, October 21, 2018
Session 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.
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 10). https://acrabstracts.org/abstract/nonsteroidal-anti-inflammatory-drug-use-and-hypertension-in-ankylosing-spondylitis/. Accessed July 2, 2020.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/nonsteroidal-anti-inflammatory-drug-use-and-hypertension-in-ankylosing-spondylitis/