Patients with rheumatoid arthritis (RA) who have increased nocturnal blood pressures and do not display the normal “dipping” decline in blood pressure may be at a high risk of developing cardiovascular issues, according to results published in the Journal of Human Hypertension. These patients may also have prominent subclinical vascular impairment.

The study included patients with RA (n=91) and controls with no cardiovascular comorbidities (n=50). Each participant had 24-hour ambulatory blood pressure monitoring. The researchers assessed arterial stiffness (via pulse wave velocity) and carotid atherosclerosis (via carotid intima-media thickness). They estimated peripheral vascular resistance from impedance cardiography. Cardiovascular risk was calculated from the Framingham Heart Study. Dipping was defined as a decline in blood pressure ≥10% of daytime values.

Compared with controls, participants with RA had a higher prevalence of non-dipping pattern, elevated nighttime systolic blood pressure, and blunted dipping.

Participants with RA showed a correlation between dipping levels and arterial stiffness, as well as a correlation between nighttime systolic blood pressure and all vascular markers and cardiovascular risk. However, after adjusting for inflammation these associations were no longer significant.

Participants with RA who had a non-dipping profile and high nighttime systolic blood pressure had significantly higher levels of arterial stiffness and cardiovascular risk compared with participants with a non-dipping profile with normal nighttime systolic blood pressure.

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“The combination of a non-dipping profile with elevated nighttime systolic blood pressure is accompanied by the highest levels of subclinical vascular damage and confers the highest cardiovascular risk among RA patients,” the researchers concluded.  

Reference

Gkaliagkousi E, Anyfanti P, Chatzimichailidou S, et al. Association of nocturnal blood pressure patterns with inflammation and central and peripheral estimates of vascular health in rheumatoid arthritis. J Hum Hypertens. 2018;32:259-267.