Rheumatology Advance Access originally published online on August 17, 2007
Rheumatology 2007 46(9):1477-1482; doi:10.1093/rheumatology/kem169
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Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis
1Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK, 2Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece, 3Wolfson Computer Laboratory, University Hospital Birmingham NHS Foundation Trust, Birmingham and 4Department of Cardiology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK.
Correspondence to: Professor George D. Kitas, MD, PhD, FRCP, Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ, UK. E-mail: gd.kitas{at}dgoh.nhs.uk; g.d.kitas{at}bham.ac.uk
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Abstract |
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Objectives. Rheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality. Hypertension (HT) contributes significantly to the development of cardiovascular disease (CVD). Little is known about the factors that influence blood pressure (BP) in patients with RA. In this study, we assessed the prevalence of HT in a secondary care cohort of RA patients, and aimed to identify factors associated with its presence and inadequate control.
Methods. A total of 400 consecutive RA patients were studied. HT was defined as systolic BP 
140 mmHg and/or diastolic BP 90 mmHg or current use of antihypertensive drugs. The association of HT with several demographic and RA-related factors, comorbidities and drugs was evaluated using logistic regression.
Results. HT was present in 282 (70.5%) patients. Of those, 171 (60.6%) received anti-hypertensive therapy, but 111 (39.4%) remained undiagnosed. Of those treated, only 37/171 (21.8%) were optimally controlled. Multivariable logistic regression revealed age (OR = 1.054, CI: 1.02 to 1.07, P = 0.001), body mass index [BMI (OR = 1.06, CI: 1.003–1.121, P = 0.038)] and prednisolone use (OR = 2.39, CI: 1.02–5.6, P = 0.045) to be independently associated with the presence of HT. BMI (OR = 1.11, CI: 1.02–1.21, P = 0.002) and the presence of CVD (OR = 4.01, CI: 1.27–12.69, P = 0.018) associated with uncontrolled HT.
Conclusions. HT is highly prevalent in RA, under-diagnosed particularly in the young, and under-treated particularly in old RA patients with CVD. RA patients receiving steroids should be specifically targeted for screening and treatment; those with any cardiovascular comorbidity may require particularly aggressive monitoring and treatment strategies.
KEY WORDS: Hypertension, Rheumatoid arthritis, Prevalence, Cardiovascular, Control
Submitted 27 April 2007;
revised version accepted 30 May 2007.
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