Vnitr Lek 2009, 55(2):111-116

The diurnal variability of blood pressure in patients with hypertension and rheumatoid arthritis

I. Řiháček^*, P. Fráňa, M. Souček, M. Plachý, B. Kianička

II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc.

Background:
The patients with rheumatoid arthritis have high prevalence of hypertension and increased risk of cardiovascular morbidity and mortality.

Objective:
To determine the level of clinical blood pressure (BP) and 24h ambulatory BP in patients with rheumatoid arthritis and hypertension. Analyze the diurnal variability of BP depending on chronic treatment with prednisone, nonsteroidal anti-inflammatory drugs and methotrexate. Group of patients: 60 patients with clinically stable rheumatoid arthritis and treated or newly diagnosed hypertension. 15 male and 45 female, mean age 58 ± 11.3 years.

Results:
Mean clinical systolic BP 139.0 ± 14.7 mm Hg, diastolic BP 85.7 ± 6.5 mm Hg and heart rate 74.9 ± 7.3 beat.min^-1. Mean 24h systolic BP 127.7 ± 12.6 mm Hg, diastolic BP 77.7 ± 7.4 mm Hg and heart rate 73.9 ± 8.7 beat.min^-1. Mean clinical pulse pressure 54.7 ± 15.6 mm Hg, mean 24h pulse pressure 50.1 ± 11.6 mm Hg. In the whole group of patients the number of systolic dippers was 28 (47%), nondippers 17 (28%), excesive dippers 11 (18%) and risers 4 (7%), diastolic dippers 27 (45%), nondippers 9 (15%), excesive dippers 22 (37%) and risers 2 (3%). The patients treated with prednisone and nonsteroidal anti-inflammatory drugs were nondippers in 34% both for systolic BP, in 19% and 20% respectively for diastolic BP. They were excessive dippers for systolic BP in 22% and 20% respectively, for diastolic BP in 37% and 38% respectively. In the course of the treatment with methotrexate were 22% patients nondippers for systolic BP and 8% for diastolic BP, 28% was excessive dippers for systolic BP, 47% for diastolic BP.

Conclusion:
Patients with rheumatoid arthritis and hypertension have a slightly increased pulse pressure (55 mm Hg for clinical BP and 50 mm Hg for 24h ambulatory BP) in comparison to arbitrary limits in generally population. Patients treated with prednison and nonsteroidal anti-inflammatory drugs were more often nondippers (34%) in systolic BP than hypertensive control. The patients treated with methotrexate (47%), prednisone (37%) and nonsteroidal anti-inflammatory drugs (38%) were more often excessive dippers in diastolic BP than hypertensive control.

Keywords: hypertension; rheumatoid arthritis; 24h ambulatory blood pressure monitoring; diurnal variability of blood pressure; cardiovascular risk

Received: November 12, 2008; Accepted: December 3, 2008; Published: February 1, 2009  Show citation