Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis

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 >= 140mmHg and/or diastolic BP >= 90 mmHg or current use of anti hypertensive 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 comorbiclity may require particularly aggressive monitoring and treatment strategies.