Background Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular diseases (CVD). RA disease activity and inflammation contributes to the increase in risk, but traditional risk factor such as hypertension and dyslipidemia also plays a significant role.
Objectives We investigated the influence of hypertension and its management on cardiovascular risk and RA-related outcomes in patients with RA.
Methods RA patients from the KORONA (Korean Observational Study Network for Arthritis) prospective multicenter cohort were assessed for demographic factors, RA-related outcomes (DAS28, HAQ, EQ-5D), traditional risk factors for CVD, and cardiovascular risks. Systemic Coronary Risk Evaluation (SCORE) risk score and Korean 10-year CVD risk score were used to assess the CVD risk. Patients with no hypertension and those with either diagnosis of hypertension or high blood pressure were compared. Among the hypertension group, patients with blood pressure below the target (140/90mmHg) and those above the target were compared. Patients with no hypertension and those with hypertension and blood pressure below target with treatment were also compared.
Results From the 5,376 patients enrolled in KORONA, 4,232 patients were included in the analysis after excluding 1,144 patients with missing information on cholesterol, smoking status, or blood pressure. Patients with hypertension or had high blood pressure were significantly younger (p<0.01), had longer disease duration (p<0.01), longer delay in diagnosis (p<0.01), higher HAQ score (p<0.01), lower EQ-5D score (p<0.01), higher disease activity (p<0.01), higher BMI (p<0.01), and more dyslipidemia (p<0.01). SCORE risk as well as the Korean 10-year CVD risk score were significantly higher in patients with hypertension and high blood pressure (p<0.01). Among the patients with hypertension, those still showing blood pressure above the target were older (p=0.47), had shorter disease duration (p=0.01), and higher SCORE risk (p<0.01) and Korean 10-year CVD risk score. When patients with no hypertension and those with hypertension but blood pressure below target with treatment were compared, patients with being treated for hypertension had higher HAQ score (p<0.01), lower EQ-5D score (p<0.01), higher disease activity (p<0.01), higher BMI (p<0.01), higher SCORE risk (p<0.01) and Korean 10-year CVD risk (p<0.01), and more dyslipidemia (p<0.01).
Conclusions Patient with hypertension are at increased risk for CVD and the risk remained higher than the patients with no hypertension even after reaching the recommended target for blood pressure control.
Acknowledgements This study is supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065).
Disclosure of Interest None Declared