RESEARCH - Long-term exposure to medium-dose steroids is associated with hypertension in patients with RA

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Rheumatology 2008 47(1):72-75; doi:10.1093/rheumatology/kem311

Long-term exposure to medium-dose glucocorticoid therapy associates with

hypertension in patients with rheumatoid arthritis

V. F. Panoulas1,2, K. M. J. 1, A. Stavropoulos-Kalinoglou1, G. S.

Metsios1, P. Nightingale3, M. D. Kita1, M. S. f2 and G. D. Kitas1,4

1Department of Rheumatology, Dudley Group of Hospitals NHS Trust, s

Hall Hospital, Dudley, West Midlands, UK, 2Department of Internal Medicine,

School of Medicine, University of Ioannina, Ioannina, Greece, 3Wolfson

Computer Laboratory, University Hospital Birmingham NHS Foundation Trust,

Birmingham and 4ARC Epidemiology Unit, Manchester University, Manchester,

UK.

Abstract

Objective. Rheumatoid arthritis (RA) associates with increased

cardiovascular morbidity and mortality that is due to both traditional and

novel cardiovascular risk factors. Hypertension (HT), one of the most common

risk factors for cardiovascular disease, is highly prevalent in RA. The

effects of long-term glucocorticoid (GC) therapy on blood pressure have not

been established yet. This study examined whether GC exposure associates

with HT in patients with RA.

Methods. Four hundred consecutive RA patients with detailed clinical and

laboratory assessments were categorized into three groups according to GC

exposure: no or limited exposure (N/L-E); a low-dose (<7.5 mg) long-term

exposure (LD/LT-E); and medium-dose (7.5 mg) long-term exposure (MD/LT-E).

The association of GC exposure with HT was evaluated using logistic

regression analysis.

Results. HT was more prevalent in the MD/LT-E group (84.7%) than the LD/LT-E

or N/L-E groups (70.7 and 67.3%, respectively, P = 0.028). Logistic

regression revealed increased odds for HT when comparing MD/LT-E with N/L-E,

after adjustment for HT risk factors [odds ratio (OR) = 2.57, 95% CI

1.01-6.56, P = 0.049] and RA disease characteristics (OR = 3.64, 95% CI:

1.36-9.77, P = 0.01).

Conclusions. MD/LT GC exposure associates with a very high prevalence of HT.

This appears to be independent of other risk factors for HT or of

channelling bias due to disease severity, even though the latter cannot be

excluded given the cross-sectional nature of our study. RA patients in this

GC exposure group should be particularly targeted for early identification

and aggressive management of HT.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/1/72

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