Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis
Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis
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DOI：
10.1093/rheumatology/kem169
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发表时间：
2007-09-01
期刊：
影响因子：
5.5
通讯作者：
Kitas, G. D.
中科院分区：
文献类型：
--
作者：
Panoulas, V. F.;Douglas, K. M. J.;Kitas, G. D.
目标.风湿性关节炎（RA）与心血管疾病的发病率和死亡率密切相关。高血压（HT）是心血管疾病（CVD）的重要发病因素。关于影响RA患者血压（BP）的因素知之甚少。在这项研究中，我们评估了类风湿关节炎患者的二级护理队列中HT的患病率，旨在确定与其存在和控制不足相关的因素。共有400名连续的RA患者进行了研究。HT定义为收缩压≥ 140 mmHg和/或舒张压≥ 90 mmHg或正在使用降压药。采用Logistic回归分析评估HT与人口统计学和RA相关因素、合并症和药物的相关性。282例（70.5%）患者存在HT。其中171例（60.6%）接受了降压治疗，但111例（39.4%）仍未确诊。在接受治疗的患者中，只有37/171（21.8%）得到了最佳控制。多变量logistic回归分析显示年龄（OR = 1.054，CI：1.02 - 1.07，P= 0.001）、体重指数[BMI（OR = 1.06，CI：1.003-1.121，P= 0.038）]和泼尼松龙使用（OR = 2.39，CI：1.02-5.6，P= 0.045）与HT的存在独立相关。BMI（OR = 1.11，CI：1.02-1.21，P= 0.002）和CVD（OR=4.01，CI：1.27-12.69，P=0.018）与未控制的HT相关。HT在RA中非常普遍，特别是在年轻人中诊断不足，特别是在患有CVD的老年RA患者中治疗不足。接受类固醇治疗的RA患者应特别针对筛查和治疗;那些有任何心血管合并症的患者可能需要特别积极的监测和治疗策略。
Objectives. Rheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality. Hypertension (HT) contributes significantly to the development of cardiovascular disease (CVD). Little is known about the factors that influence blood pressure (BP) in patients with RA. In this study, we assessed the prevalence of HT in a secondary care cohort of RA patients, and aimed to identify factors associated with its presence and inadequate control.Methods. A total of 400 consecutive RA patients were studied. HT was defined as systolic BP >= 140mmHg and/or diastolic BP >= 90 mmHg or current use of anti hypertensive drugs. The association of HT with several demographic and RA-related factors, comorbidities and drugs was evaluated using logistic regression.Results. HT was present in 282 (70.5%) patients. Of those, 171 (60.6%) received anti-hypertensive therapy, but 111 (39.4%) remained undiagnosed. Of those treated, only 37/171 (21.8%) were optimally controlled. Multivariable logistic regression revealed age (OR = 1.054, CI: 1.02 to 1.07, P= 0.001), body mass index [BMI (OR = 1.06, CI: 1.003-1.121, P= 0.038)] and prednisolone use (OR = 2.39, CI: 1.02-5.6, P= 0.045) to be independently associated with the presence of HT. BMI (OR = 1.11, CI: 1.02-1.21, P= 0.002) and the presence of CVD (OR=4.01, CI: 1.27-12.69, P=0.018) associated with uncontrolled HT.Conclusions. HT is highly prevalent in RA, under-diagnosed particularly in the young, and under-treated particularly in old RA patients with CVD. RA patients receiving steroids should be specifically targeted for screening and treatment; those with any cardiovascular comorbiclity may require particularly aggressive monitoring and treatment strategies.