Change in arterial stiffness and ambulatory blood pressure in patients with rheumatoid arthritis: the jointheart study

Objective: Use of disease modifying antirheumatic drugs (DMARDs) has been associated with reduction in blood pressure (BP) and arterial stiffness in clinical trials, but real-word data is lacking. We investigated change in ambulatory BP and arterial stiffness in outpatients with rheumatoid arthritis (RA) eligible for initiation or change in targeted synthetic (ts) or biological (b) DMARDs. Design and method: Eighty-nine consecutive RA patients (age 53±13, 68% women) were examined at initiation of ts/bDMARDs and repeated after 22 months. Ambulatory BP, carotid-femoral-pulse wave velocity (cfPWV) and Disease Activity Score in 28 joints using C-reactive protein (DAS28) were measured at baseline and at follow-up. High cfPWV was defined as cfPWV > 10 m/s in accordance with guidelines. Results: At follow-up, 20% used tsDMARDs, 57% bDMARDs and 67% had achieved remission or low disease activity. DAS28 decreased from 3.9±1.3 at baseline to 2.8±1.2 at follow-up (p<0.001). The ambulatory systolic BP increased (116±11 mmHg vs 120±13 mmHg, p = 0.010), while the ambulatory diastolic BP decreased (76±7 mmHg vs. 73±8 mmHg, p = 0.001) from baseline to follow-up. Body mass index (BMI) increased from 26.5±5.2 kg/m 2 to 27.1±4.9 kg/m 2 , p = 0.009. Changes in ambulatory systolic and diastolic BP were associated with presence of diabetes at baseline, but not DAS28 or use of ts or bDMARDs. Mean cfPWV increased from 7.8±1.6 m/s at baseline to 8.5±1.8 m/s at follow-up (p<0.001). The prevalence of high cfPWV increased from 10.8% to 16.3 %, p = 0.03. DAS28 (beta = 0.32, p = 0.01) and diabetes at baseline (beta = 0.39, p = 0.001) were associated with increase in cfPWV, independent of achieved remission/low disease activity at follow-up, baseline systolic BP, BMI, age, sex and use of antihypertensive drugs. Conclusions: In outpatients with RA, higher disease activity at baseline was associated with an increase in arterial stiffness during follow-up, despite DMARD therapy and significant decrease in disease activity.