Hypertension in autoimmune rheumatic diseases – a position paper from the ESH working group on small arteries

Clinical management of hypertension in patients with autoimmune rheumatic diseases (ARDs) is challenging. Firstly, the impact on blood pressure (BP) of several antirheumatic drugs varies and the available evidence points towards a wide range of effects. Secondly, management of hypertension in terms of diagnosis, BP thresholds and therapeutic targets currently follows the general recommendations, even though patients with ARDs present a markedly adverse cardiovascular profile. Thirdly, lifestyle interventions in terms of non-pharmaceutical management follow the general recommendations. Notably, it has been shown that they can improve autoimmune disease-specific endpoints, however, their intimate effect on BP has not been fully explored. Finally, the choice of anti-hypertensive medication currently complies with the general antihypertensive therapy recommendations, in the absence of appropriately designed studies in these populations. This review aims to summarize the impact of antirheumatic drugs on BP and present the available data regarding clinical management of hypertension in patients with ARDs.