Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated with Changes in Blood Pressure

Joshua F. Baker, Brian Sauer, Chia Chen Teng, Michael George, Grant W. Cannon, Said Ibrahim, Amy C Cannella, Bryant England, Kaleb D Michaud, Liron Caplan, Lisa A. Davis, James Robert O'Dell, Ted R Mikuls

Research output: Contribution to journalArticle

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Abstract

Purpose This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database. Methods We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication. Results A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β =-1.08 [-1.32 to-0.85]; P < 0.0001) and DBP (β =-0.48 [-0.62 to-0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21-1.91]; P < 0.001). Conclusions Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.

Original languageEnglish (US)
Pages (from-to)203-209
Number of pages7
JournalJournal of Clinical Rheumatology
Volume24
Issue number4
DOIs
StatePublished - Jun 1 2018

Fingerprint

leflunomide
Rheumatoid Arthritis
Methotrexate
Blood Pressure
Hydroxychloroquine
Hypertension
Antirheumatic Agents
Therapeutics
Databases
Sulfasalazine
Veterans
Prednisone
Antihypertensive Agents
Prescriptions
Tumor Necrosis Factor-alpha

Keywords

  • blood pressure
  • disease-modifying antirheumatic drugs
  • rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated with Changes in Blood Pressure. / Baker, Joshua F.; Sauer, Brian; Teng, Chia Chen; George, Michael; Cannon, Grant W.; Ibrahim, Said; Cannella, Amy C; England, Bryant; Michaud, Kaleb D; Caplan, Liron; Davis, Lisa A.; O'Dell, James Robert; Mikuls, Ted R.

In: Journal of Clinical Rheumatology, Vol. 24, No. 4, 01.06.2018, p. 203-209.

Research output: Contribution to journalArticle

Baker, Joshua F. ; Sauer, Brian ; Teng, Chia Chen ; George, Michael ; Cannon, Grant W. ; Ibrahim, Said ; Cannella, Amy C ; England, Bryant ; Michaud, Kaleb D ; Caplan, Liron ; Davis, Lisa A. ; O'Dell, James Robert ; Mikuls, Ted R. / Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated with Changes in Blood Pressure. In: Journal of Clinical Rheumatology. 2018 ; Vol. 24, No. 4. pp. 203-209.
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abstract = "Purpose This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database. Methods We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication. Results A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β =-1.08 [-1.32 to-0.85]; P < 0.0001) and DBP (β =-0.48 [-0.62 to-0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9{\%} more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21-1.91]; P < 0.001). Conclusions Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.",
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AU - Sauer, Brian

AU - Teng, Chia Chen

AU - George, Michael

AU - Cannon, Grant W.

AU - Ibrahim, Said

AU - Cannella, Amy C

AU - England, Bryant

AU - Michaud, Kaleb D

AU - Caplan, Liron

AU - Davis, Lisa A.

AU - O'Dell, James Robert

AU - Mikuls, Ted R

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N2 - Purpose This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database. Methods We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication. Results A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β =-1.08 [-1.32 to-0.85]; P < 0.0001) and DBP (β =-0.48 [-0.62 to-0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21-1.91]; P < 0.001). Conclusions Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.

AB - Purpose This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database. Methods We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication. Results A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β =-1.08 [-1.32 to-0.85]; P < 0.0001) and DBP (β =-0.48 [-0.62 to-0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21-1.91]; P < 0.001). Conclusions Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.

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