Multiple studies have demonstrated that patients with rheumatoid arthritis (RA) have a marked increase in the number of cardiovascular events such as strokes and heart attacks. While various theories have been offered, it is clear that multiple factors are involved.

Chronic inflammation appears to be the major underlying factor. Chronic inflammation sets up atherosclerosis and the attendant development of plaque. However, other factors such as genetic predisposition, cigarette smoking, and diabetes contribute as well.

One of the most important risk factors that can be modified is high blood pressure. And... unfortunately, this problem- high blood pressure- is extremely common in patients with RA.

Furthermore, according to a recent study (Panoulas VF, et al. Rheumatol. 2007; 46: 1477-1482), it is often under diagnosed and poorly controlled in patients with RA.

The authors studied 400 patients with RA who attended outpatient clinics in the United Kingdom.

Hypertension was found in 282 (70.5%). Only 171 (60.6%) of these patients had received a diagnosis of hypertension and were on drug therapy for it. The other 111 patients (39.4%) had not been diagnosed with hypertension.

The undiagnosed hypertension was most common in patients ranging in age from 35 to 54 years than in older patients.

More disturbing is that of the 171 patients with hypertension who were receiving treatment, only 37 (21.6%) were optimally controlled.

Predictors of uncontrolled hypertension in this group were elevated Body Mass Index and the presence of concomitant cardiovascular disease.

The researchers stated that, "The young and elderly overweight patients with RA should be specifically screened for hypertension..."

They also made the point- and a crucial one at that- that those patients with already existing cardiovascular disease must be identified and treated aggressively and monitored closely to ensure proper blood pressure targets are reached.

The take home message is quite clear. Patients with RA are at increased risk for hypertension and often the hypertension is under diagnosed and suboptimally managed.

About the Author

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment