Target organ damage in patients with rheumatoid arthritis: The role of blood pressure and heart rate

Background: Rheumatoid arthritis (RA) is characterised by increased cardiovascular morbidity and mortality. Even though hypertension (HT) is highly prevalent in RA, the extent of target organ damage (TOD) caused by it remains unknown. Inflammation and sympathetic overdrive may also associate with TOD. We investigated the prevalence and associations of TOD in RA. Methods: In this cross-sectional, observational study, 251 RA patients with no overt cardiovascular or renal disease had extensive clinical and laboratory evaluations, including a 12-lead electrocardiogram and urine albumin: creatinine ratio. Pulse pressure (PP) was used as a proxy of arterial stiffness and heart rate (HR) of autonomic activity. TOD was defined as described in the European guidelines for the management of arterial hypertension. Binary logistic regression analysis was used to evaluate the independence of the variables that associated with the presence of TOD. Results: TOD prevalence was 23.5% (59/251). Of the 59 patients with TOD, 45.8% had suboptimally controlled HT, whereas 32.3% had undiagnosed HT. In univariable analysis, TOD was significantly associated with higher age (64.2 +/- 11.7 years vs. 58.0 +/- 12.4 years, p = 0.001), HT prevalence (89.8% vs. 60.4%, p < 0.001), systolic blood pressure (SBP) (150.3 +/- 18.8mmHg vs. 139.7 +/- 20.7mmHg, p = 0.001), PP (70.6 perpendicular to 16.6mmHg vs. 60.3 perpendicular to 17.3mmHg, p < 0.001), HR (77.1 perpendicular to 15.4bpm vs. 72.2 perpendicular to 12.2 bpm, p < 0.001), serum uric acid (320.6 +/- 88.8 mu mol/l vs. 285.0 +/- 74.9 mu mol/l, p = 0.03) and type 2 diabetes mellitus prevalence (13.6% vs. 4.7%, p = 0.019). Binary logistic regression analysis revealed that only hypertension indices and HR associated independently with TOD. Conclusions: TOD is highly prevalent in patients with RA and associates independently with hypertension, arterial stiffness and heart rate. Further prospective studies are needed to confirm these findings and examine the role of beta-blockers in this particular population. (C) 2009 Elsevier Ireland Ltd. All rights reserved.