AB0353 WORSE OFFICE AND 24-HOUR BRACHIAL AND CENTRAL AORTIC BLOOD PRESSURE MONITORING PROFILE IN PATIENTS WITH RHEUMATOID ARTHRITIS COMPARED TO CONTROLS
Authors: Elena Troitskaya, Sergei Velmakin, Svetlana Villevalde, Zhanna Kobalava
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Hypertension (HTN) contributes to increased cardio-vascular (CV) morbidity and mortality in RA. Recent European guidelines on the management of HTN encourage wider use of ambulatory blood pressure (BP) monitoring (ABPM) that provides more accurate information about BP control compared to conventional BP measurement. Central blood pressure (CBP) may be a better predictor of CV risk compared to brachial BP <h3>Objectives</h3> <b>T</b>o evaluate office and ambulatory brachial and central BP levels in patients with RA compared to the controls. <h3>Methods</h3> Study group included 85 patients with RA (77.6% females,age 59.7±14.3 years, HTN 65%, median HTN duration 6.6 years, RA duration - 7 years, seropositive RA 65%, DAS-28(CRP) 3.7±1.1, median hsCRP 10 mg/dl, RF 51.3 IU/ml, all received DMARDs) and control group (40 patients matched by gender, age and risk factors). All hypertensives received antihypertensive therapy. Office CBP was measured with applanation tonometry. CBP elevation was assessed according to individual reference values by gender and age. 24-hour ABPM of peripheral and central BP was performed with BPLab Vasotens. p&lt;0.05 was considered significant. <h3>Results</h3> In patients without HTN mean office brachial and central BP levels were similar in RA and control groups. In patients with HTN corresponding BP levels were: 138±17/82±10 vs 130±16/74±11 mmHg (p=0.04 for SBP;p&lt;0.001 for DBP) and 132±20/82±10 vs 120±17/74±12mmHg (p=0.01 for SBP;p=0.001 for DBP). Rate of BP control was 58% in RA and 67% in the controls (p=0.48). CBP elevation was observed in 42.4% of RA patients and 17.5% controls (χ<sup>2</sup>=14.9,p=0.0001):16.7% vs 0% in the normotensive group (χ<sup>2</sup>=6.0,p=0.01) and 56.4% vs 29.2% in HTN group (χ<sup>2</sup>=9.9,p=0.002), respectively. In the normotensives mean daytime, nighttime and 24-h BP levels were similar in RA and control groups. In HTN 24-h brachial SBP levels for RA and control group were 134±17 vs 125±9mmHg for daytime (p=0.02); 128±17 vs 113±10 mmHg for nighttime (p=0.01) and 131±16 vs 123±9 mmHg for 24-h BP (p=0.02), respectively. The 24-h central BP levels were 124±14 vs 115±14 mmHg for daytime (p=0.02), 121±16 vs 111±10 mmHg for the nighttime (p=0.02) and 123±15 vs 115±8 mmHg for 24-h BP (p=0.02), respectively. Group with RA had higher incidence of masked and isolated nocturnal HTN compared to controls (35.3 vs 17.5% (χ<sup>2</sup>=3.7,p=0.05) and 29.4 vs 12.5% (χ<sup>2</sup>=4.3,p=0.04). In normotensives corresponding frequencies of masked and isolated nocturnal HTN were 33.3 vs 12.5% (p&gt;0.05) and 26.7 vs 6.3% (χ<sup>2</sup>=3.3,p=0.04), respectively. In HTN group rate of masked uncontrolled HTN was 36.3 vs 2.5%, respectively, rate of uncontrolled night HTN-30.9 vs 20.8% (p&gt;0.05). <h3>Conclusion</h3> Despite similar BP control rate, patients with RA were characterized by significantly higher levels of office brachial and central BP, worse control of CBP and higher frequency of masked and isolated nocturnal HTN compared to controls. Hypertensive RA patients had higher 24-h brachial and central SBP. This indicates the importance of 24-h ABPM in RA. <h3>References</h3> [1] Panoulas VF, et al. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology2007; 46:1477-82. [2] Herbert A. et al. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J. 2014;35(44):3122-33 [3] Williams B, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018;36(10):1953-2041 <h3>Disclosure of Interests</h3> Elena Troitskaya: None declared, Sergei Velmakin: None declared, Svetlana Villevalde Speakers bureau: Servier, Novartis Pharma, Boehringer Ingelheim, Gedeon Richter, Astra Zeneka, Takeda, Berlin-Chemie AG, Zhanna Kobalava Speakers bureau: Servier, Novartis Pharma, Boehringer Ingelheim, Astra Zeneka, Takeda