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Blood pressure changes in patients with recent-onset rheumatoid arthritis treated with four different treatment strategies: a post hoc analysis from the BeSt trial
  1. Naomi B Klarenbeek1,
  2. Sjoerd M van der Kooij1,
  3. Tineke J W Huizinga1,
  4. Yvonne P M Goekoop-Ruiterman1,
  5. Harry M J Hulsmans2,
  6. Michiel V van Krugten3,
  7. Irene Speyer4,
  8. Jeska K de Vries-Bouwstra1,
  9. Pit J S M Kerstens5,
  10. Tom W J Huizinga1,
  11. Ben A C Dijkmans5,6,
  12. Cornelia F Allaart1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
  3. 3Department of Rheumatology, Walcheren Hospital, Vlissingen, The Netherlands
  4. 4Department of Rheumatology, Bronovo Hospital, The Hague, The Netherlands
  5. 5Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  6. 6Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
  1. Correspondence to N B Klarenbeek, Department of Rheumatology, C-01-R, Leiden University Medical Center, P O Box 9600, Leiden 2300 RC, The Netherlands; n.b.klarenbeek{at}


Objective To evaluate the effect of disease activity and antirheumatic treatment on blood pressure (BP) in patients with recent-onset rheumatoid arthritis (RA).

Methods 508 patients with RA were randomised to receive (1) sequential monotherapy, (2) step-up combination therapy, (3) initial combination with prednisone or (4) with infliximab. Systolic and diastolic BP (SBP, DBP), disease activity score (DAS) and body mass index (BMI) were evaluated every 3 months. A linear mixed model was used to model SBP and DBP in each treatment group during year 1, adjusting for baseline BP, changes in BMI, DAS and cardiovascular medication.

Results In all groups, mean SBP and DBP were lower for patients with DAS ≤2.4 than for patients with DAS >2.4. In addition, patients initially treated with infliximab (group 4) had a larger decrease in SBP and DBP over time than patients in groups 1–3. The decrease in BP was also observed in patients treated with infliximab after failure on conventional disease-modifying antirheumatic drugs in groups 1–3. The decrease in BP associated with treatment with infliximab occurred irrespective of the DAS response.

Conclusion A lower DAS is associated with lower BP. An additional decrease in BP was observed in patients treated with infliximab. Further research is needed to confirm the effect of infliximab on BP.

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  • Funding This study was funded by a grant of the Dutch College of Health Insurances (College Voor Zorgverzekeringen) with additional funding provided by Schering-Plough, B.V. and Centocor, Inc. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of all data, the writing of this article and the decision to publish.

  • Ethics approval This study was conducted with the approval from all participating centres of the trial. All patients gave written informed consent before screening and entering the trial.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Competing interests TWJH, BACD and CFA received speaker fees of less than $10000 per year from different pharmaceutical companies.