Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension 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 4ARC Epidemiology Unit, Manchester University, Manchester, UK.
Correspondence to: G. D. Kitas, 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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Objective. Rheumatoid arthritis (RA) associates with increased cardiovascular morbidity and mortality that is due to both traditional and novel cardiovascular risk factors. Hypertension (HT), one of the most common risk factors for cardiovascular disease, is highly prevalent in RA. The effects of long-term glucocorticoid (GC) therapy on blood pressure have not been established yet. This study examined whether GC exposure associates with HT in patients with RA.
Methods. Four hundred consecutive RA patients with detailed clinical and laboratory assessments were categorized into three groups according to GC exposure: no or limited exposure (N/L-E); a low-dose (<7.5 mg) long-term exposure (LD/LT-E); and medium-dose (
7.5 mg) long-term exposure (MD/LT-E). The association of GC exposure with HT was evaluated using logistic regression analysis.
Results. HT was more prevalent in the MD/LT-E group (84.7%) than the LD/LT-E or N/L-E groups (70.7 and 67.3%, respectively, P = 0.028). Logistic regression revealed increased odds for HT when comparing MD/LT-E with N/L-E, after adjustment for HT risk factors [odds ratio (OR) = 2.57, 95% CI 1.01–6.56, P = 0.049] and RA disease characteristics (OR = 3.64, 95% CI: 1.36–9.77, P = 0.01).
Conclusions. MD/LT GC exposure associates with a very high prevalence of HT. This appears to be independent of other risk factors for HT or of channelling bias due to disease severity, even though the latter cannot be excluded given the cross-sectional nature of our study. RA patients in this GC exposure group should be particularly targeted for early identification and aggressive management of HT.
KEY WORDS: Glucocorticoids, Steroids, Hypertension, Cardiovascular disease, Rheumatoid arthritis
Submitted 6 September 2007;
revised version accepted 25 October 2007.
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  V. F. Panoulas, G. S. Metsios, A. V. Pace, H. John, G. J. Treharne, M. J. Banks, and G. D. Kitas Hypertension in rheumatoid arthritis Rheumatology, May 29, 2008; (2008) ken159v2. [Abstract] [Full Text] [PDF]
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