Hypertension may be underdiagnosed in rheumatoid arthritis patients

Patients with rheumatoid arthritis are nearly 30% less likely to be diagnosed with hypertension than those without the disease, a study found.

Researchers studied adult patients with and without rheumatoid arthritis/inflammatory arthritis from a large academic multispecialty practice. All were seen regularly in primary care and met clinical guideline hypertension criteria but lacked prior hypertension diagnosis/treatment.

Results appeared online at Arthritis Care & Research.

Among 14,974 patients with undiagnosed hypertension, 201 (1.3%) had rheumatoid arthritis. Patients with rheumatoid arthritis patients had equal numbers of primary care visits and more total medical visits compared to patients without the condition (5.4 compared to 2.3, including on average of 2.6 rheumatology visits annually). The likelihood of hypertension diagnosis was 36% in rheumatoid arthritis patients compared to 51% without rheumatoid arthritis (HR=0.71; 95% CI, 0.55 to 0.93).

Researchers noted that patients with comorbid diabetes or hyperlipidemia were more likely to be diagnosed with hypertension (hazard ratios [HR] 1.27 and 1.09, respectively). Patients between the ages of 60 and 79 years had the highest rate of diagnosis (HR=1.42; 95% CI, 1.31 to 1.54), black patients had the next (HR=1.28; 95% CI, 1.14 to 1.44), and current smokers had a lower rate of hypertension diagnosis (HR=0.88; 95% CI, 0.82 to 0.96).

Given that rheumatoid arthritis patients have a 50% to 60% increased incidence of cardiovascular disease (CVD) events and premature death, hypertension diagnosis should be a key step in managing the condition, the authors noted.

“Patients with diabetes and hyperlipidemia also experienced higher diagnosis, likely reflecting concordant CVD risk perceptions, and well-known, guideline-driven practices for CVD risk management,” the authors wrote. “RA (rheumatoid arthritis) patients, in contrast, may be suffering from the lack of provider awareness regarding RA as a concordant CVD risk. Lower hypertension diagnosis in active smokers was particularly concerning given that health care providers should be more vigilant to traditional CVD risk factors like hypertension in patients who smoke.”