Impact of Rheumatoid Arthritis on Receiving a Diagnosis of Hypertension Among Patients With Regular Primary Care

Abstract

Objective Despite numerous studies reporting increased cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), the impact of RA on managing modifiable CVD risk factors remains understudied. We tested the hypothesis that RA is a risk factor for not receiving a hypertension diagnosis. Methods Using a cohort design, we studied adult patients with and without RA/inflammatory arthritis from a large academic multispecialty practice. All were seen regularly in primary care and met clinical guideline hypertension criteria but lacked prior hypertension diagnosis/treatment. The primary outcome was time to ICD-9 code for hypertension or elevated blood pressure, or antihypertensive medication prescription. Kaplan Meier (KM) Survival and Cox proportional hazard modeling were used to examine the impact of RA on diagnosis of hypertension. Results Among 14,974 patients with undiagnosed hypertension, 201 patients had RA codes. RA patients had equivalent primary care visits and more total visits compared to patients without RA. At study end the likelihood of hypertension diagnosis was 36% in RA patients compared to 51% without RA. In adjusted Cox models, RA patients had 29% lower hypertension diagnosis hazard [Hazard Ratio 0.71, 0.55–0.93], reflecting more undiagnosed hypertension than with other comorbidities. Conclusion Among patients meeting guideline-based hypertension criteria, RA patients were less likely to be diagnosed despite more visits than those without RA. Given heightened CVD risks in RA, and the importance of hypertension diagnosis as a first step toward controlling risk, rheumatologists should collaborate to improve rates of diagnosis for this modifiable CVD risk factor.

Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives

“…Our study offers potential explanations for prior reports documenting low lipid testing and lower hypertension diagnosis in RA patients compared to their peers (5, 9, 11). Moreover we offer the first map of unique process gaps, conditions, and strategies that demonstrates how that occurs.…”

“…Although rheumatoid arthritis (RA) independently increases cardiovascular disease (CVD) risk (1)(2)(3)(4), many RA patients receive suboptimal CVD preventive care (5)(6)(7)(8). We and others have reported disparities in lipid, diabetes mellitus, and hypertension care among RA patients compared to peers (5,7,(9)(10)(11)(12). Mortality and care gaps continue (13)(14)(15) despite published recommendations for RA-CVD risk management by the European League Against Rheumatism (EULAR), global experts, and other professional societies (16)(17)(18).…”

Incidence and Management of Cardiovascular Risk Factors in Psoriatic Arthritis and Rheumatoid Arthritis: A Population‐Based Study

“…Patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) . Previous studies have demonstrated that cardiovascular risk factors such as hypertension, hyperlipidemia, and obesity are highly prevalent, underdiagnosed, and poorly controlled among patients with inflammatory arthritis . However, relatively little is known from a population‐based perspective about the screening and management of cardiovascular risk factors in these patients, particularly among patients with PsA.…”

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

“…Moreover, in RA, HTN is associated with asymptomatic cardiovascular organ damage on echocardiography, independent of inflammatory activity [67]. One study showed a 29% gap in diagnosis of HTN in RA patients compared to non-RA patients using longitudinal blood pressures [68]. Interestingly, a premier US multispecialty group that used hypertension protocols demonstrated no gap [69].…”