title: Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care.
abstract: OBJECTIVE
  Despite numerous studies reporting increased cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), the impact of RA on managing modifiable CVD risk factors remains understudied. We tested the hypothesis that RA is a risk factor for not receiving a hypertension diagnosis.
  
  
  METHODS
  Using a cohort design, we studied adult patients with and without RA/inflammatory arthritis from a large academic multispecialty practice. All were seen regularly in primary care and met clinical guideline hypertension criteria, but lacked prior hypertension diagnosis/treatment. The primary outcome was time to International Classification of Diseases, Ninth Revision code for hypertension or elevated blood pressure, or antihypertensive medication prescription. Kaplan-Meier survival curve analysis and Cox proportional hazards modeling were used to examine the impact of RA on diagnosis of hypertension.
  
  
  RESULTS
  Among 14,974 patients with undiagnosed hypertension, 201 patients had RA codes. RA patients had equivalent primary care visits and more total visits compared to patients without RA. At the end of the study, the likelihood of hypertension diagnosis was 36% in RA patients compared to 51% in patients without RA. In adjusted Cox models, RA patients had a 29% lower hypertension diagnosis hazard (hazard ratio 0.71, 95% confidence interval 0.55-0.93), reflecting more undiagnosed hypertension than with other comorbidities.
  
  
  CONCLUSIONS
  Among patients meeting guideline-based hypertension criteria, RA patients were less likely to be diagnosed despite more visits than those without RA. Given heightened CVD risks in RA and the importance of hypertension diagnosis as a first step toward controlling risk, rheumatologists should collaborate to improve rates of diagnosis for this modifiable CVD risk factor.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Heather
authors.initials: H
authors.lastname: Johnson
authors.forename: Katya
authors.initials: K
authors.lastname: Voelker
authors.forename: Carolyn
authors.initials: C
authors.lastname: Thorpe
authors.forename: Patrick
authors.initials: P
authors.lastname: McBride
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.forename: Maureen
authors.initials: M
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012307:Risk Factors; D055815:Young Adult