title: Longterm blood pressure variability in patients with rheumatoid arthritis and its effect on cardiovascular events and all-cause mortality in RA: a population-based comparative cohort study.
abstract: OBJECTIVE
  To examine longterm visit-to-visit blood pressure (BP) variability in patients with rheumatoid arthritis (RA) versus non-RA subjects and to assess its effect on cardiovascular (CV) events and mortality in RA.
  
  
  METHODS
  Clinic BP measures were collected in a population-based incident cohort of patients with RA (1987 American College of Rheumatology criteria met between January 1, 1995, and January 1, 2008) and non-RA subjects. BP variability was defined as within-subject SD in systolic and diastolic BP.
  
  
  RESULTS
  The study included 442 patients with RA (mean age 55.5 yrs, 70% females) and 424 non-RA subjects (mean age 55.7 yrs, 69% females). Patients with RA had higher visit-to-visit variability in systolic BP (13.8 ± 4.7 mm Hg) than did non-RA subjects (13.0 ± 5.2 mm Hg, p = 0.004). Systolic BP variability declined after the index date in RA (p < 0.001) but not in the non-RA cohort (p = 0.73), adjusting for age, sex, and calendar year of RA. During the mean followup of 7.1 years, 33 CV events and 57 deaths occurred in the RA cohort. Visit-to-visit systolic BP variability was associated with increased risk of CV events (HR per 1 mm Hg increase in BP variability 1.12, 95% CI 1.01-1.25). Diastolic BP variability was associated with all-cause mortality in RA (HR 1.14, 95% CI 1.03-1.27), adjusting for systolic and diastolic BP, body mass index, smoking, diabetes, dyslipidemia, and use of antihypertensives.
  
  
  CONCLUSIONS
  Patients with RA had higher visit-to-visit systolic BP variability than did non-RA subjects. There was a significant decline in systolic BP variability after RA incidence. Higher visit-to-visit BP variability was associated with adverse CV outcomes and all-cause mortality in RA.
authors.affiliation: From the Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.E. Myasoedova, MD, PhD; C.S. Crowson, MS, Department of Health Sciences Research, and the Division of Rheumatology; A.B. Green, MS, Department of Health Sciences Research; E.L. Matteson, MD, MPH; S.E. Gabriel, MD, MSc, Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine.
authors.forename: Elena
authors.initials: E
authors.lastname: Myasoedova
authors.affiliation: From the Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.E. Myasoedova, MD, PhD; C.S. Crowson, MS, Department of Health Sciences Research, and the Division of Rheumatology; A.B. Green, MS, Department of Health Sciences Research; E.L. Matteson, MD, MPH; S.E. Gabriel, MD, MSc, Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine. crowson@mayo.edu.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: From the Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.E. Myasoedova, MD, PhD; C.S. Crowson, MS, Department of Health Sciences Research, and the Division of Rheumatology; A.B. Green, MS, Department of Health Sciences Research; E.L. Matteson, MD, MPH; S.E. Gabriel, MD, MSc, Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Green
authors.affiliation: From the Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.E. Myasoedova, MD, PhD; C.S. Crowson, MS, Department of Health Sciences Research, and the Division of Rheumatology; A.B. Green, MS, Department of Health Sciences Research; E.L. Matteson, MD, MPH; S.E. Gabriel, MD, MSc, Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: From the Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.E. Myasoedova, MD, PhD; C.S. Crowson, MS, Department of Health Sciences Research, and the Division of Rheumatology; A.B. Green, MS, Department of Health Sciences Research; E.L. Matteson, MD, MPH; S.E. Gabriel, MD, MSc, Department of Health Sciences Research, and the Division of Rheumatology, Mayo Clinic College of Medicine.
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000959:Antihypertensive Agents; D018501:Antirheumatic Agents
keywords: BLOOD PRESSURE VARIABILITY; RHEUMATOID ARTHRITIS; TRENDS