Background Erratic blood pressure (BP) has been linked to increased risk of cardiovascular (CV) events and death in the general population. The impact of BP variability on CV events and mortality in RA is much less studied.
Objectives To examine long-term visit-to-visit BP variability in RA vs non-RA subjects and to assess the impact of BP variability on CV events and all-cause mortality in RA.
Methods The study included a population-based incident cohort of RA patients (1987 ACR criteria first met between 1980 and 2007) and a cohort of non-RA subjects of similar age and sex. All available clinic BP measures were collected from the medical records. BP variability was defined as within-subject standard deviation (SD) in systolic and diastolic BP. Cox models were used to examine the effect of BP variability on CV events (i.e. hospitalized/silent myocardial infarction, CV mortality, heart failure, ischemic heart disease, angina, or revascularization procedures) and all-cause mortality in RA.
Results 452 RA patients (mean age 55.5 years, 31% males) and 436 non-RA subjects (mean age 55.7 years, 31% males) had ≥1 BP measure and were included. During the mean follow-up of 7.1±2.7 years in RA and 7.2±2.6 years in the non-RA cohort there were 13,470 BP measures in RA and 9,476 in the non-RA subjects (median: 24.0 measures/subject in RA and 16.5 in non-RA cohort). Median time between the measurements: 30 days in RA vs 27 in the non-RA cohort (p=0.93). The mean systolic BP at RA incidence/index date was higher in RA vs non-RA cohort (131.2±18.7 mmHg vs 128.2±19.3 mm Hg, p=0.018); the mean diastolic BP was similar in RA (75.1±10.9 mm Hg) vs non-RA cohort (75.6±11.0 mm Hg, p=0.53). There were 290 (64%) patients with hypertension in RA vs 241 (55%) in the non-RA cohort at index date. The proportion of hypertensive subjects on antihypertensive drugs was similar in RA and non-RA cohort at index date (33% vs 30%, respectively, p=0.52) and during the follow-up (33% vs 31% at 10 years, respectively, p=0.20). Patients with RA had higher visit-to-visit variability in systolic BP (13.8±4.7 mm Hg), but not diastolic BP, than the non-RA subjects (13.0±5.2 mm Hg, p=0.004). During the follow-up, 33 CV events and 57 deaths occurred in the RA cohort. Higher visit-to-visit BP variability was associated with increased risk of CV events (systolic BP: hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.04-1.29; diastolic BP: HR 1.15, 95%CI 1.02-1.30) and all-cause mortality in RA (systolic BP: HR 1.10, 95%CI 1.03-1.17; diastolic BP: HR 1.22, 95%CI 1.11-1.34). Adjusting for systolic and diastolic BP, body mass index and smoking at index date, and for time dependent covariates (i.e. diabetes, dyslipidemia, use of antihypertensives), systolic BP variability remained associated with the risk of CV events (HR 1.15, 95%CI 1.02-1.3); diastolic BP variability was associated with all-cause mortality (HR 1.14, 95%CI 1.03-1.27).
Conclusions Patients with RA had higher long-term visit-to-visit variability of systolic BP than non-RA subjects. Higher visit-to-visit variability in systolic and diastolic BP was associated with adverse CV outcomes and all-cause mortality in RA, suggesting the need for increased awareness of adverse outcomes in RA patients with unstable BP.
Disclosure of Interest None Declared
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