Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated With Changes in Blood Pressure

Baker, Joshua F.; Sauer, Brian C.; Teng, Chia‐Chen; George, Michael; Cannon, Grant W.; Ibrahim, Said A.; Cannella, Amy C.; England, Bryant R.; Michaud, Kaleb; Caplan, Liron; Davis, Lisa; O'Dell, James Robert; Mikuls, Ted R.

doi:10.1097/rhu.0000000000000736

Cited by 22 publications

(27 citation statements)

References 26 publications

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“…1.21-1.91)) 104 . By contrast, those patients starting methotrexate were 9% more likely to achieve an optimal blood pressure (<130/90 mmHg) after 6 months of treatment.…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

et al. 2019

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“…1.21-1.91)) 104 . By contrast, those patients starting methotrexate were 9% more likely to achieve an optimal blood pressure (<130/90 mmHg) after 6 months of treatment.…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

et al. 2019

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“…Observational cross-sectional and prospective studies in rheumatoid arthritis have also shown that methotrexate use is associated with lower systolic and diastolic blood pressure and reduced incidence of hypertension, when compared to other DMARDs or no treatment [103][104][105][106][107][108]. In one of these studies, the associations between methotrexate treatment and lower blood pressure were also observed for 24-hr measures of peripheral and central blood pressure [103].…”

Section: Methotrexate Endothelial Function Arterial Stiffness and mentioning

confidence: 94%

Methotrexate and Vasculoprotection: Mechanistic Insights and Potential Therapeutic Applications in Old Age

Mangoni

Tommasi

Zinellu

et al. 2019

CPD

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Increasing age is a strong, independent risk factor for atherosclerosis and cardiovascular disease. Key abnormalities driving cardiovascular risk in old age include endothelial dysfunction, increased arterial stiffness, blood pressure, and the pro-atherosclerotic effects of chronic, low-grade, inflammation. The identification of novel therapies that comprehensively target these alterations might lead to a major breakthrough in cardiovascular risk management in the older population. Systematic reviews and meta-analyses of observational studies have shown that methotrexate, a first-line synthetic disease-modifying anti-rheumatic drug, significantly reduces cardiovascular morbidity and mortality in patients with rheumatoid arthritis, a human model of systemic inflammation, premature atherosclerosis, and vascular aging. We reviewed in vitro and in vivo studies investigating the effects of methotrexate on endothelial function, arterial stiffness, and blood pressure, and the potential mechanisms of action involved. The available evidence suggests that methotrexate might have beneficial effects on vascular homeostasis and blood pressure control by targeting specific inflammatory pathways, adenosine metabolism, and 5' adenosine monophosphate-activated protein kinase. Such effects might be biologically and clinically relevant not only in patients with rheumatoid arthritis but also in older adults with high cardiovascular risk. Therefore, methotrexate has the potential to be repurposed for cardiovascular risk management in old age because of its putative pharmacological effects on inflammation, vascular homeostasis, and blood pressure. However, further study and confirmation of these effects are essential in order to adequately design intervention studies of methotrexate in the older population.

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“…Furthermore, treatment with leflunomide was associated with a significantly lower rate of myocardial infarction in comparison with patients with RA receiving other medications 45. In contrast to other csDMARDs, leflunomide may, however, increase blood pressure and aggravate hypertension 51…”

Section: Impact Of Medication On Development Of Heart Disease In Ramentioning

confidence: 98%

Pathogenesis of ischaemic and non-ischaemic heart diseases in rheumatoid arthritis

Błyszczuk

Szekanecz

2020

RMD Open

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Rheumatoid arthritis (RA) is characterised by a chronic inflammatory condition of the joints, but the comorbidities of RA predominantly contribute to the reduced lifespan associated with this disease. Clinical data indicate that cardiovascular disease is the major comorbidity associated with mortality in RA. In this review, we aimed to describe the pathogenesis of heart failure in RA. First, we emphasised the fundamental differences between ischaemic and non-ischaemic heart diseases and referred to their relevance in excessive cardiovascular-dependent mortality in RA. Second, we highlighted aspects of asymptomatic changes in cardiac tissue and in coronary blood vessels that are commonly found in patients with diagnosed RA. Third, we focused on high-grade systemic inflammation as a key trigger of ischaemic and non-ischaemic heart diseases in RA, and described the implication of conventional and biologic antirheumatic medications on the development and progression of heart disease. In particular, we discussed the roles of tumour necrosis factor-alpha (TNF-α) and anti-TNF-α therapies on the development and progression of ischaemic and non-ischaemic heart diseases in RA.

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Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated With Changes in Blood Pressure

Abstract: Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.

Cited by 22 publications

References 26 publications

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

Methotrexate and Vasculoprotection: Mechanistic Insights and Potential Therapeutic Applications in Old Age

Pathogenesis of ischaemic and non-ischaemic heart diseases in rheumatoid arthritis

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