Background Rheumatoid arthritis is associated with increased cardiovascular risk. Nocturnal hypertension and non-dipping status are important determinants of cardiovascular mortality and morbidity. Little is known about their associations in patients with RA.
Objectives The aim of the study was to assess the prevalence of nocturnal hypertension and its associations in patients with RA.
Methods 62 patients with RA (EULAR 2010) without known cardio-vascular disease were examined (73% females, age 58,5±15,4 (M±SD) years, 13% smokers, 61% with AH, 34% with dyslipidemia). Median duration of RA was 8 years (IQR 3–17). Seropositive RA was diagnosed in 69% of patients. Median CRP was 12,1 mg/dl (IQR 2,2–23,4 mg/dl), median rheumatoid factor (RF) was 32,5 IU/ml (IQR 8,3–173 IU/ml). All patients received disease-modifying antirheumatic drugs, 22 (38%) - biological treatment. Median duration of AH was 6,1 years (IQR 0–10 years. All patients with AH received antihypertensive treatment. 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, “Petr Telegin”). Arterial stiffness was assessed by applanation tonometry (Sphygmocor, AtCor, Australia). P<0.05 was considered significant.
Results Mean office BP was 130±15/80±10 mmHg. Mean pulse wave velocity (PWV) was 9,3±3,2 m/s. The dipping states were as follows: non-dipping in 39 (62,9%) patients, dipping – In 7 (11,3%), extreme dipping – in 5 (8,1%) and reverse dipping in 11 (17,7%). Median of nocturnal fall in systolic BP was 3,5% (IQR 0–9%). Isolated nocturnal AH was observed in 12 (19,4%) pts. Patients were divided into 2 groups according to nocturnal fall of BP: G1 (non-dipping - >10%) – 42 (67,7%) pts and G2 (dipping- <10%.) – 16 (32,3%) pts. Non-dippers were older (56,7±16,2 vs 49±12,5 years), more often were smokers (20 vs 0%), had higher BMI (25,4±6,0 vs 22,3±5,1 kg/m2), median duration of AH (1,5; IQR 0–11 vs 0; min 0, max 1 years), median duration of RA (10; IQR 7–19 vs 2,5; IQR 2–6,5 years), PWV (8,6±2,8 vs 7,2±2,1 m/s), nocturnal BP (120,4±12,7/69,8±10,4 vs 103,8±8,8/59,4±4,4 mmHg), p<0,05 for trend. Spearmen analysis revealed significant correlations between nocturnal fall in SBP and RA duration (r=-0,3), central BP (r=0,2 for SBP and DBP), night SBP and DBP (r=-0,3 and -0,5 respectively), p<0,05 for trend. Multiple regression analysis showed that elevation of central office DBP and night DBP were significant predictors of non-dipping state (β=-3,7, p=0,008 and -0,7, p<0,0001 respectively).
Conclusions The majority of patients with rheumatoid arthritis are characterized by non-dipping state. Diastolic nocturnal hypertension is a significant predictor of non-dipping in this patient population.
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Disclosure of Interest None declared
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