Background Cardiovascular (CV) events are the main reason of increased mortality at patients with rheumatoid arthritis (RA). Arterial hypertension (AH) takes a leading position among CV risk factors in RA. Ambulatory blood pressure monitoring (ABPM) has to be executed for persons with high cardiovascular risk and can be used for evaluation of “masked” arterial hypertension (MAH), according to the current recommendations.
Objectives to estimate the frequency of identification and peculiarities of the MAH according to ambulatory blood pressure monitoring in women with RA without CV diseases.
Methods The study included 36 women with RA (ACR 1987 and/or EULAR/ACR 2010 criteria) without CV diseases and AH (according to the anamnesis and 3-fold “office” blood pressure (BP) measurement). Mean age of RA patients was 55±7.15 years; mean duration of RA was 10 [3; 17] years, mean DAS 28 – 5.25 [4.6; 5.7]. As controls were involved 39 women with RA and AH (mean age- 58.3±6.08 years; mean duration of RA - 8 [4;14] years, mean DAS 28- 5.08 [4.04; 5.85]) and 30 women with AH without inflammatory joint diseases (mean age 55.9±6.2). Exclusion criteria were smoking, diabetes mellitus, symptomatic AH (except controls), cardiovascular diseases.
ABPM was measured using the BPlab with the program VASOTENSE (Russian). Criteria for MAH were out-of-office BP ≥135/85 mmHg and/or average daily out-of-office BP ≥130/80 mmHg according to ABPM and considering optimal office BP.
The anamnesis, laboratory and instrumental methods of inspection were considered. Statistical analyze was performed with STATISTICA 7.0 (State Soft, USA).
Results According to ABPM 24 of the 36 (66.6%) RA patients had optimal BP, 12 (33.3%) patients had the MAH phenomenon.
The patients with RA + AH and AH patients had the comparable levels of a daily BP [132.1/80.7 and 126.9/78.0 mmHg respectively, p>0.05].
The RA patients with MAH had statistically significant differences of BP in day and night hours [137.58/87 mmHg and 137/84 mmHg, respectively] compared to the RA + AH patients [132.1/80.7 mmHg and 128.3/73.8 mmHg, respectively, p=0.004] and AH patients [126.9/78 and 118/68.5 mmHg, respectively, p=0.001], what it is can be bound to absence of anti-hypertensive therapy at RA patients with MAH.
Nocturnal systolic BP correlated with ESR (Spearmen's r=0.64, p<0.05). Daily diastolic BP interrelated with SCORE/EULAR (r=0.86, p<0.05) and arterial stiffness index (r=0.86, p<0.05) in RA patients with MAH; nocturnal systolic BP correlated with C-reactive protein (r=0.36, p<0.05) in RA+AH patients.
More than 60% of the RA+AH patients and RA+MAH had high variability of BP. High variability of nocturnal systolic BP occurred at 34.3% and 44.4% of RA+AH and RA+MAH patients, respectively.
In RA patients were found correlations between indices of a BP variability, duration of RA (r=0.33, p<0.05); C-reactive protein (r=0.36, p<0.05); daily diastolic BP (r=0.35, p<0.05); pulse BP (r=0.31, p<0.05); and frequency of non-steroidal anti-inflammatory drugs intake (r=0.42, p<0.05).
Conclusions In RA patients AH can proceed subclinically. Activity of RA and increased arterial stiffness can predict the masked arterial hypertension's development in RA patients.
ABPM measurement can be use full in early evaluation of AH and optimization of RA treatment.
Disclosure of Interest None declared
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