POS0562 PULSE PRESSURE AS AN INDICATOR OF SUBCLINICAL ATHEROSCLEROSIS IN RHEUMATOID ARTHRITIS
Authors: S. Lugo-Perez, I. J. Colunga-Pedraza, J. R. Azpiri-López, D. Á. Galarza-Delgado, N. Guajardo-Jauregui, A. B. Rodriguez-Romero, A. Cárdenas, A. C. Garza Acosta
Journal: Annals of the Rheumatic Diseases (2021)

Background: Pulse pressure (PP) is defined as the difference between systolic and diastolic blood pressure and represents arterial compliance and reflective properties of blood flow (1). It is well known that gender, age, and race / ethnicity are intrinsic factors of the patient that influence PP. Brachial PP has recently been associated with markers of subclinical cardiovascular disease after adjustment with traditional cardiovascular risk factors in the general population (2). However, this relationship has not been studied in patients with rheumatoid arthritis (RA) and its identification would allow earlier adjustments of cardiovascular therapies in this high-risk group. Objectives: The aim of the study is to analyze the difference in PP between patients with RA and healthy controls. Additionally, to analyze the difference between patients with carotid plaque (CP) and without CP. Methods: A cross-sectional, observational, and comparative study of ninety-two patients with RA aged 40-75 years and who fulfilled ACR/EULAR 2010 classification criteria. Also, we included ninety-two controls without RA, matched by gender, age and comorbidities. A carotid ultrasound was performed in patients with RA and it was divided into two subgroups, with the presence of CP and without CP. A blood pressure measurement was taken after 15 minutes of rest on the right arm of all patients. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p value &lt;0.05 was considered statistically significant. Results: We found no statistical difference between groups regarding age, gender and, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) (Table 1). There was a significant difference in PP between patients with RA and controls (50 mmHg vs 41 mmHg respectively, p = 0.032). Patients with RA had a significant difference in PP of patients with CP and without CP (50 mmHg vs 44 mmHg respectively, p = 0.008) (Figure 1). When performing a binary logistic regression, it was found that PP was the only independent factor for the presence of CP in patients with RA, OR 1.054 (95% CI 1.008-1.101, p = 0.020). Conclusion: Patients with RA had a higher PP than controls. Binary logistic regression showed PP as the only independent factor for the presence of subclinical atherosclerosis in patients with RA. PP is a parameter that all rheumatologists should consider when evaluating cardiovascular risk in patients with RA. References: [1]Winston GJ, Palmas W, Lima J, et al. Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Hypertens 2013;26(5):636-42. doi: 10.1093/ajh/hps092 [2]Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke 1999;30(3):550-5. doi: 10.1161/01.str.30.3.550 Table 1. Demographic characteristics. RA (n=92 ) Control (n=92 ) p Women, n (%) 85 (92.4) 85 (92.4) NS Age, years ± SD 58.0 (55.0-63.0) 56.5 (54.0-61.0) NS T2DM, n (%) 17 (18.5) 15 (16.3) NS Hypertension, n (%) 33 (35.9) 33 (35.9) NS Dyslipidemia, n (%) 30 (32.6) 29 (31.5) NS Obesity, n (%) 30 (32.6) 31 (33.7) NS Active smoking, n (%) 11 (12.0) 20 (21.7) NS RA patients with CP (n=39 ) RA patients without CP (n=53 ) p Women, n (%) 36 (92.3) 49 (92.5) NS Age, years ± SD 60.13 ± 5.98 58.08 ± 7.00 NS T2DM, n (%) 9 (23.1) 8 (15.1) NS Hypertension, n (%) 16 (41.0) 17 (32.1) NS Dyslipidemia, n (%) 13 (33.3) 17 (32.1) NS Obesity, n (%) 15 (38.5) 15 (28.3) NS Active smoking, n (%) 6 (15.4) 5 (9.4) NS Disease duration, years (p25-p75) 8.44 (3.00-15.50) 12.86 (4.66-19.66) NS NS, no significant; T2DM, type 2 diabetes mellitus; CP, carotid plaque. Disclosure of Interests: None declared