Some rheumatoid arthritis Treatments linked to Improvement in BP

Baker et.al conducted a study to evaluate the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years.They used administrative Veterans Affairs database for the purpose and found that Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. .The study has been published in Journal of Clinical Rheumatology.

The researchers in a 3-year study, involving >20,000 individuals, found that certain disease-modifying therapies for rheumatoid arthritis (RA) may have a positive effect on blood pressure.

The researchers used the Veterans Affairs electronic medical record databases to identify unique dispensing of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone in order to assess the effect of these treatments on systolic and diastolic blood pressure (SBP and DBP), as well as incident hypertension among RA patients.

The analysis showed no changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation (P>.62). However, over the 6 months following initiation of treatment, there was a decline in SBP of β= −1.08 (−1.32 to −0.85; P<.0001) and DBP of β= −0.48 (−0.62 to −0.33; P<.0001).

The greatest BP declines were noted in patients taking methotrexate and hydroxychloroquine; those who initiated methotrexate were 9% more likely to have optimal blood pressure at 6 months. In contrast, leflunomide was tied to increases in BP, and a greater incidence of hypertension when compared to methotrexate (hazard ratio 1.53 [1.21-1.91; P<.001]). In multivariate models, sulfasalazine and hydroxychloroquine users had a similar risk of incident hypertension when compared with methotrexate.

The Authors concluded that Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.