Abnormal phenotypes of 24-h blood pressure monitoring and their associations with inflammation and arterial stiffness in patients with rheumatoid arthritis

Objective. To evaluate the 24-h profile of brachial and aortic blood pressure (BP) in patients with rheumatoid arthritis (RA) compared to the controls and to investigate the associations of the abnormalities. Design and methods. The cross-sectional study included 85 patients with RA (males 22,4 %, aged 59,7 ± 14,3 years, hypertension (HTN) in 65 %, mean DAS-28 (C-reactive protein, CRP) 3,7 ± 1,1) and control group (40 patients matched by gender, age and risk factors). Office brachial BP was measured with a validated oscillometric device, 24-hour ambulatory blood pressure monitoring (ABPM) by BPLab Vasotens, arterial stiffness and aortic BP by applanation tonometry. Cardiovascular (CV) risk was calculated as mSCORE (EULAR recommended modified version). P < 0,05 was considered significant. Results. The rate of BP control was 58 % in RA and 67 % in the control group (p = 0,48). Patients with RA and HTN compared to matched controls had higher levels of brachial and aortic office, mean daytime, nighttime and 24-h systolic BP (SBP), patients with RA without HTN showed higher brachial night SBP (113 ± 10 vs 105 ± 9 mmHg, p = 0,02). All patients with RA had higher rate of masked HTN (28,2 % vs 7,5 %, p = 0,009), night SBP and DBP elevation (56,5 % vs 17,5 %, p < 0,001; 26,7 % vs 0 %, p = 0,02, in the group without HTN, respectively), isolated nocturnal HTN (30,6 % vs 5 %, p = 0,001) and non-dipping (83,5 % vs 62,5 %, p = 0,02). Univariate analysis revealed significant associations of night brachial SBP with age (r = 0,5), office SBP (r = 0,6) and diastolic BP (DBP) (r = 0,3), carotid-femoral (cf) pulse wave velocity (PWV) (r = 0,5) and mSCORE (r = 0,5); non-dipping pattern was associated with age (r = 0,22) and night brachial and aortic DBP (r = 0,36 and 0,35, respectively), p < 0,05 for trend. Multivariate analysis confirmed independent associations of night brachial SBP with cfPWV (β = 0,43, p = 0,009) and non-dipping with night brachial DBP (β = 0,57, p = 0,007). Non-dippers with elevated night SBP had the highest levels of cfPWV, CRP and mSCORE compared to dippers and non-dippers with normal night SBP. Conclusions. High incidence of night SBP elevation does not depend on the history of HTN and is associated with cfPWV increase. Nondipping state correlates with elevation of night brachial DBP. Combination of non-dipping state with night HTN is associated with arterial stiffness and higher CV risk. Inflammation might mediate these associations. © 2019 All-Russian Public Organization Antihypertensive League. All rights reserved.