Target organ damage in patients with rheumatoid arthritis: the role of blood pressure and heart rate.
BACKGROUND
Rheumatoid arthritis (RA) is characterised by increased cardiovascular morbidity and mortality. Even though hypertension (HT) is highly prevalent in RA, the extent of target organ damage (TOD) caused by it remains unknown. Inflammation and sympathetic overdrive may also associate with TOD. We investigated the prevalence and associations of TOD in RA.


METHODS
In this cross-sectional, observational study, 251 RA patients with no overt cardiovascular or renal disease had extensive clinical and laboratory evaluations, including a 12-lead electrocardiogram and urine albumin:creatinine ratio. Pulse pressure (PP) was used as a proxy of arterial stiffness and heart rate (HR) of autonomic activity. TOD was defined as described in the European guidelines for the management of arterial hypertension. Binary logistic regression analysis was used to evaluate the independence of the variables that associated with the presence of TOD.


RESULTS
TOD prevalence was 23.5% (59/251). Of the 59 patients with TOD, 45.8% had suboptimally controlled HT, whereas 32.3% had undiagnosed HT. In univariable analysis, TOD was significantly associated with higher age (64.2+/-11.7 years vs. 58.0+/-12.4 years, p=0.001), HT prevalence (89.8% vs. 60.4%, p<0.001), systolic blood pressure (SBP) (150.3+/-18.8mmHg vs. 139.7+/-20.7mmHg, p=0.001), PP (70.6+/-16.6mmHg vs. 60.3+/-17.3mmHg, p<0.001), HR (77.1+/-15.4bpm vs. 72.2+/-12.2bpm, p<0.001), serum uric acid (320.6+/-88.8mumol/l vs. 285.0+/-74.9mumol/l, p=0.03) and type 2 diabetes mellitus prevalence (13.6% vs. 4.7%, p=0.019). Binary logistic regression analysis revealed that only hypertension indices and HR associated independently with TOD.


CONCLUSIONS
TOD is highly prevalent in patients with RA and associates independently with hypertension, arterial stiffness and heart rate. Further prospective studies are needed to confirm these findings and examine the role of beta-blockers in this particular population.
Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, West Midlands, UK. bpanoulas@hotmail.com
Vasileios F
VF
Panoulas
Tracey E
TE
Toms
Giorgos S
GS
Metsios
Antonios
A
Stavropoulos-Kalinoglou
Athanasios
A
Kosovitsas
Haralampos J
HJ
Milionis
Karen M J
KM
Douglas
Holly
H
John
George D
GD
Kitas
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000473:pathology* / Q000503:physiopathology*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index