Hypertension being missed in rheumatoid arthritis

GPs have been urged to screen patients with rheumatoid arthritis (RA) for hypertension, after UK research revealed it was not picked up in four out of 10 RA patients.

The study findings add weight to previous calls for the addition of RA to the quality framework.

It is known that RA is associated with an increased risk of cardiovascular events such as MI, stroke and heart failure.

But for this latest study, the researchers investigated the prevalence of hypertension in 400 patients with RA.

Measurements of BP were taken and patient records were examined for use of any hypertensive medications.

More than 280 patients were found to have hypertension. Of these, only 61 per cent were found to be taking any medication for it. The remainder had undiagnosed, untreated hypertension. Of the RA patients receiving hypertension treatment, only 22 per cent had it under control.

Lead researcher Professor George Kitas, a consultant rheumatologist in Birmingham, said: ‘RA behaviour is similar to diabetes in terms of CVD risk. GPs have been conditioned to control CVD in diabetic patients and should look to adopt a similar approach in RA patients.’

GPs should be more aware of the risks of hypertension in RA patients, said Professor Kitas.

‘The link is not documented as well as the increased risk of cardiovascular events,’ he said.

‘Including RA in the quality framework would help GPs to monitor RA patients’ BP and treat it as necessary.’

GPs should be careful when prescribing for RA patients with hypertension because drugs such as NSAIDs and oral steroids can increase BP, added Professor Kitas.

Dr David Armstrong, consultant rheumatologist from University Hospital in North Durham, said: ‘I have been an advocate of aggressive screening and treatment of risk factors like hypertension in RA patients in primary care. RA should be treated with the same priority as diabetes.’

Brighton GP Dr Sue Lips­combe also backed screening. She said many RA patients had inflamed arteries, causing vessels to swell and narrowing of the lumen.

‘This will lead to increased peripheral resistance and higher numbers with hypertension.’

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