Abstrato

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.