Key result
Higher rheumatoid arthritis disease activity links to blunted nocturnal BP dipping, which improves with treatment.
Why the study?
The relationship between nocturnal blood pressure and disease activity in rheumatoid arthritis patients was not well understood despite both being predictors of cardiovascular disease.
Does RA therapeutic intervention improve nocturnal blood pressure fall in patients with rheumatoid arthritis?
Observational (n=71)
Does RA therapeutic intervention improve nocturnal blood pressure fall in patients with rheumatoid arthritis?
Effect estimate: β = -0.388
p-value: p=0.004
Higher rheumatoid arthritis disease activity is associated with a blunted nocturnal blood pressure fall, which can be improved with RA-specific therapeutic intervention.
Active RA may blunt nocturnal BP dipping, warranting vigilance; hypothesis-generating for treatment effects, needs RCTs before practice change.
OBJECTIVES: Both nocturnal hypertension (HT) and systemic inflammation underlying rheumatoid arthritis (RA) have been shown to be independent predictors of cardiovascular disease (CVD), although little is known on the relationship between nocturnal blood pressure (BP) and disease activity in RA patients. METHODS: We performed 24-hour ambulatory BP monitoring (ABPM) in 71 RA patients to examine the relationship of nocturnal fall in BP and RA disease activity based on a disease activity score of 28 joint counts with C-reactive protein (CRP, 28-joint disease activity score (DAS28)-CRP). Among them, 25 RA patients whose consent obtained were reexamined by ABPM to assess the improvement of nocturnal fall in BP after RA therapeutic intervention. RESULTS: The mean DAS28-CRP level was 4.8±1.6 in 71 RA patients. The mean nocturnal fall in BP was 5.6±8.9%. DAS28-CRP was associated significantly and independently in a negative manner with the nocturnal fall in BP (β = -0.388, P = 0.004). In 25 RA patients, DAS28-CRP improved from 5.4±1.1 to 3.5±0.8 (P < 0.0001) and the nocturnal fall in BP increased significantly from 4.5±9.2% to 10.6±5.8% (P = 0.002) with the significant decrease of nighttime systolic BP (SBP) from 121.2±22.5mm Hg to 112.5±18.8mm Hg (P = 0.02) in spite of no change in daytime BP after 4 weeks of RA treatment. CONCLUSIONS: The present study observed that higher RA activity was associated with lower nocturnal fall in BP, but not daytime BP, in RA patients.
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Hamamoto et al. (2015) conducted an observational in Rheumatoid Arthritis (n=71). Rheumatoid arthritis disease activity was evaluated on Nocturnal fall in blood pressure (β = -0.388, p=0.004). Higher rheumatoid arthritis disease activity was associated with a lower nocturnal fall in blood pressure (β = -0.388, P=0.004), which improved from 4.5% to 10.6% after 4 weeks of RA treatment.
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