Arterial hypertension assessed “out-of-office” in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated “white coat” phenomenon

Abstract

IntroductionRheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk, whereas arterial hypertension is a major modifiable CVD risk factor with still unclear prevalence in RA disease. We conducted a comprehensive study on hypertension characteristics evaluating for the first time out-of-office blood pressure (BP) in a typical contemporary RA cohort.MethodsAssessment of office and out-of-office BP (when office systolic/diastolic BP was >129/79) and vascular studies including evaluation of aortic stiffness, carotid hypertrophy/plaques and ankle-brachial index, were performed in 214 consecutive, consenting RA patients free of CVD (aged 58.4 ± 12.3 years, 82% women). As comparators regarding office hypertension measurements, data from 214 subjects (1:1 matched for age and gender with the RA patients) derived from a cohort designed to assess the prevalence of hypertension in the general population were used.ResultsThe prevalence of declared known hypertension in the RA population was 44%. Of the remaining RA patients, 2 in every 5 individuals had abnormal office BP (systolic/diastolic >139/89 mmHg), contributing to almost double the prevalence of declared/office hypertension compared to the general matched population (67% vs. 34%). Out-of-office (home or ambulatory 24 hour) BP measurements revealed that: (i) a 54% prevalence of actual hypertension in RA, in other words almost 10% of the patients were unaware of having hypertension and (ii) 29% of the RA patients with known hypertension were not well controlled. Actual hypertension was positively associated with age and body mass index, and inversely with the use of biologic drugs. Overall, almost 1 out of 5 presented the 'white coat’ phenomenon. An intermediately compromised vascular phenotype was evident in this “white coat” subgroup (lying between patients with sustained normotension and sustained hypertension) in terms of aortic stiffness, carotid hypertrophy and ankle-brachial index, even after adjustment for confounders.ConclusionBeyond any doubt on the basis of out-of-office evaluation, arterial hypertension in RA has a high prevalence, low awareness and poor control, as well as substantial and vascular damage-associated “white coat” phenomenon. Thus, correct diagnosis and effective treatment of hypertension is of key importance in RA for CVD risk reduction.

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

“…Despite general recognition that patients with RA are at increased risk of CVD events, there is ample evidence that even well established CVD risk factors such as hypertension and dyslipidemia are not identified and managed consistently in RA populations (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). One strategy to reduce CVD risk in RA is therefore to better identify and manage modifiable risk factors such as smoking, hypertension, obesity and dyslipidemia.…”

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

“…Although the association between smoking and CV risk in RA is less significant than in the general population [Symmons and Gabriel, 2011], a higher prevalence of smoking is well-established in RA, SA, and PsA compared with controls [Boyer et al 2011;Divecha et al 2005;Favato, 2008;Peters et al 2004]. Hypertension is common in RA but it is not clear whether its incidence differs from that of the general population [Boyer et al 2011;Liao and Solomon, 2013;Protogerou et al 2013]. This condition may affect nearly half of all RA patients, is often under-diagnosed, and poorly controlled [Bartels et al 2014;Protogerou et al 2013].…”

“…Hypertension is common in RA but it is not clear whether its incidence differs from that of the general population [Boyer et al 2011;Liao and Solomon, 2013;Protogerou et al 2013]. This condition may affect nearly half of all RA patients, is often under-diagnosed, and poorly controlled [Bartels et al 2014;Protogerou et al 2013]. Diabetes prevalence is increased in RA compared with controls (OR 1.74; 95% CI 1.22-2.50) [Boyer et al 2011].…”

Masked Arterial Hypertension in Employed Adult Women: Aspects of Screening and Prognostication

“…Среди факторов риска развития сердечно-сосудистых заболеваний (ССЗ) у больных РА ведущее место занимает артериальная гипертен-зия (АГ) [4,5]. По данным литературы, распростра-ненность АГ у больных РА колеблется от 40% до 70% [5][6][7]. Так, согласно результатам греческого исследо-вания ATTICA, по данным "офисного" измерения АГ встречается у 54% больных РА, еще 10% больных РА не знают о наличии у них АГ [6].…”

“…По данным литературы, распростра-ненность АГ у больных РА колеблется от 40% до 70% [5][6][7]. Так, согласно результатам греческого исследо-вания ATTICA, по данным "офисного" измерения АГ встречается у 54% больных РА, еще 10% больных РА не знают о наличии у них АГ [6].…”