RESEARCH - Blood pressure changes in patients with recent-onset RA treated with four different treatment strategies: BeSt

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Ann Rheum Dis 2010;69:1342-1345 doi:10.1136/ard.2009.124180

Clinical and epidemiological research

Concise report

Blood pressure changes in patients with recent-onset rheumatoid

arthritis treated with four different treatment strategies: a post hoc

analysis from the BeSt trial

Naomi B Klarenbeek1, Sjoerd M van der Kooij1, Tineke J W Huizinga1,

P M Goekoop-Ruiterman1, Harry M J Hulsmans2, Michiel V van

Krugten3, Irene Speyer4, Jeska K de Vries-Bouwstra1, Pit J S M

Kerstens5, Tom W J Huizinga1, Ben A C Dijkmans5,6, Cornelia F Allaart1

+ Author Affiliations

1Department of Rheumatology, Leiden University Medical Center, Leiden,

The Netherlands

2Department of Rheumatology, Haga Hospital, The Hague, The Netherlands

3Department of Rheumatology, Walcheren Hospital, Vlissingen, The Netherlands

4Department of Rheumatology, Bronovo Hospital, The Hague, The Netherlands

5Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The

Netherlands

Abstract

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 ≤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.

Conclusion 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.

http://ard.bmj.com/content/69/7/1342.abstract

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