title: Blood pressure changes in patients with recent-onset rheumatoid arthritis treated with four different treatment strategies: a post hoc analysis from the BeSt trial.
abstract: 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 < or =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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, C-01-R, Leiden University Medical Center, P O Box 9600, Leiden 2300 RC, The Netherlands. n.b.klarenbeek@lumc.nl
authors.forename: Naomi B
authors.initials: NB
authors.lastname: Klarenbeek
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: van der Kooij
authors.forename: Tineke J W
authors.initials: TJ
authors.lastname: Huizinga
authors.forename: Yvonne P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.forename: Harry M J
authors.initials: HM
authors.lastname: Hulsmans
authors.forename: Michiel V
authors.initials: MV
authors.lastname: van Krugten
authors.forename: Irene
authors.initials: I
authors.lastname: Speyer
authors.forename: Jeska K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
authors.forename: Pit J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Ben A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000911:Antibodies, Monoclonal / Q000494:pharmacology / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D015992:Body Mass Index; D004359:Drug Therapy, Combination; D006801:Humans; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000494:pharmacology / Q000627:therapeutic use; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate