Blood pressure changes in patients with recent-onset rheumatoid arthritis treated with four different treatment strategies: a post hoc analysis from the BeSt trial.
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.
Klarenbeek
Naomi B
NB
Department of Rheumatology, C-01-R, Leiden University Medical Center, P O Box 9600, Leiden 2300 RC, The Netherlands. n.b.klarenbeek@lumc.nl
van der Kooij
Sjoerd M
SM
Huizinga
Tineke J W
TJ
Goekoop-Ruiterman
Yvonne P M
YP
Hulsmans
Harry M J
HM
van Krugten
Michiel V
MV
Speyer
Irene
I
de Vries-Bouwstra
Jeska K
JK
Kerstens
Pit J S M
PJ
Huizinga
Tom W J
TW
Dijkmans
Ben A C
BA
Allaart
Cornelia F
CF
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
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate