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Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Ivan Rihacek, Petr Nemec, Michal Rihacek, Bohuslav Kianicka, Andrius Berukstis, Martin Caprnda, Ludovit Gaspar, Peter Kruzliak*, Miroslav Soucek

Background: To assess hypertension related cardiovascular risk parameters in patients with rheumatoid arthritis. To determine the effect of long-term treatment with corticosteroids, non-steroid antiinflammatory drugs, and methotrexate on diurnal BP variability. Material and methods: 60 patients with clinically stable rheumatoid arthritis and treated hypertension. Casual blood pressure measurement and 24-hour ambulatory blood pressure monitoring. Results: Mean casual systolic blood pressure 139.0 ± 14.6 mmHg, diastolic blood pressure 85.7 ± 6.5 mmHg, and heart rate 74.9 ± 7.2 beats.min-1. Mean 24-hour systolic blood pressure 129.0 ± 12.7 mmHg, diastolic blood pressure 77.6 ± 7.4 mmHg, and heart rate 73.9 ± 8.7 beats.min-1. Mean casual pulse pressure 54.7 ± 15.6 mmHg, and the mean 24-hour ambulatory pulse pressure 50.1 ± 11.0 mmHg. The mean morning surge of systolic blood pressure 35.3 ± 11.00 mmHg. The number of patients with increased short-term variability of their systolic blood pressure using the coefficient of variation 30 (50%). A number of systolic nondippers in the group were treated with corticosteroids and non-steroidal anti-inflammatory drugs 34% and 35%, respectively, and a number of excessive diastolic dippers in the group were treated with methotrexate 49%. Conclusions: Certain hypertension characteristics in patients with rheumatoid arthritis can increase cardiovascular risk: Higher pulse pressure, elevated levels of morning surge of systolic blood pressure, increased short-term 24-hour blood pressure variability, higher number of systolic nondippers treated with corticosteroids and non-steroidal anti-inflammatory drugs, and excessive diastolic dippers treated with methotrexate. In addition increased heart rate may contribute to higher cardiovascular risk.