SAT0103 Non-dipping status is associated with diastolic nocturnal hypertension in patients with rheumatoid arthritis
Authors: E Troitskaya, S Velmakin, S Villevalde, Z Kobalava
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis is associated with increased cardiovascular risk. Nocturnal hypertension and non-dipping status are important determinants of cardiovascular mortality and morbidity. Little is known about their associations in patients with RA. <h3>Objectives</h3> The aim of the study was to assess the prevalence of nocturnal hypertension and its associations in patients with RA. <h3>Methods</h3> 62 patients with RA (EULAR 2010) without known cardio-vascular disease were examined (73% females, age 58,5±15,4 (M±SD) years, 13% smokers, 61% with AH, 34% with dyslipidemia). Median duration of RA was 8 years (IQR 3–17). Seropositive RA was diagnosed in 69% of patients. Median CRP was 12,1 mg/dl (IQR 2,2–23,4 mg/dl), median rheumatoid factor (RF) was 32,5 IU/ml (IQR 8,3–173 IU/ml). All patients received disease-modifying antirheumatic drugs, 22 (38%) - biological treatment. Median duration of AH was 6,1 years (IQR 0–10 years. All patients with AH received antihypertensive treatment. 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, "Petr Telegin"). Arterial stiffness was assessed by applanation tonometry (Sphygmocor, AtCor, Australia). P&lt;0.05 was considered significant. <h3>Results</h3> Mean office BP was 130±15/80±10 mmHg. Mean pulse wave velocity (PWV) was 9,3±3,2 m/s. The dipping states were as follows: non-dipping in 39 (62,9%) patients, dipping – In 7 (11,3%), extreme dipping – in 5 (8,1%) and reverse dipping in 11 (17,7%). Median of nocturnal fall in systolic BP was 3,5% (IQR 0–9%). Isolated nocturnal AH was observed in 12 (19,4%) pts. Patients were divided into 2 groups according to nocturnal fall of BP: G1 (non-dipping - &gt;10%) – 42 (67,7%) pts and G2 (dipping- &lt;10%.) – 16 (32,3%) pts. Non-dippers were older (56,7±16,2 vs 49±12,5 years), more often were smokers (20 vs 0%), had higher BMI (25,4±6,0 vs 22,3±5,1 kg/m<sup>2</sup>), median duration of AH (1,5; IQR 0–11 vs 0; min 0, max 1 years), median duration of RA (10; IQR 7–19 vs 2,5; IQR 2–6,5 years), PWV (8,6±2,8 vs 7,2±2,1 m/s), nocturnal BP (120,4±12,7/69,8±10,4 vs 103,8±8,8/59,4±4,4 mmHg), p&lt;0,05 for trend. Spearmen analysis revealed significant correlations between nocturnal fall in SBP and RA duration (r=-0,3), central BP (r=0,2 for SBP and DBP), night SBP and DBP (r=-0,3 and -0,5 respectively), p&lt;0,05 for trend. Multiple regression analysis showed that elevation of central office DBP and night DBP were significant predictors of non-dipping state (β=-3,7, p=0,008 and -0,7, p&lt;0,0001 respectively). <h3>Conclusions</h3> The majority of patients with rheumatoid arthritis are characterized by non-dipping state. Diastolic nocturnal hypertension is a significant predictor of non-dipping in this patient population. <h3>References</h3> Androulakis E., Papageorgiou A., Chatzistamatiou E. et al. Improving the detection of preclinical organ damage in newly diagnosed hypertension: nocturnal hypertension versus non-dipping pattern J Hum Hypertens 2015;29:689–695. Redon J., Lurbe E. Nocturnal blood pressure versus nondipping pattern. What do they mean? Hypertension 2008;51:41–42. Kim B., Kim Y., Lee Y. A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort. J Korean Med Sci 2013;28:1468–1473. Hamamoto K., Yamada S., Yasumoto M. et al. Association of nocturnal hypertension with disease activity in rheumatoid arthritis. Am J Hypertens 2016;29:340–7. <h3>Disclosure of Interest</h3> None declared