Talking About Hypertension and RA

High blood pressure often not discussed in rheumatoid arthritis visits

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Patients with rheumatoid arthritis (RA) have a higher risk for heart disease, yet research suggests that high blood pressure — a risk factor for heart disease — often goes undiagnosed in these patients. So researchers set out to see if rheumatologists were talking about high blood pressure with their patients.

A recent study showed that many rheumatologists and RA patients could be having more conversations about high blood pressure (hypertension).

"Get your blood pressure checked regularly."

This study was led by Christie M. Bartels, MD, who is on the faculty of the University of Wisconsin School of Medicine and Public Health in Madison.

The study was based on electronic health record searches from 2004 to 2011 that identified RA patients who had uncontrolled or undiagnosed hypertension and who had visited one of three rheumatology clinics.

Undiagnosed hypertension was defined as three or more blood pressure readings of 140/90 or more or two readings of 160/100 or more. Controlled blood pressure was considered having three or more consecutive blood pressure readings under 140/90.   

Out of 1,267 patients, 501 had uncontrolled hypertension and 232 weren’t diagnosed as hypertensive.

The average patient age was 62 years. A total of 76 percent of patients were female, 11 percent were current smokers and 35 percent were former smokers. Less than 20 percent had prior heart conditions.

This study included 2,677 rheumatologist visits.

Normal blood pressure was defined as systolic blood pressure under 120. Prehypertension was defined as a systolic blood pressure of 120 to less than 140. Stage I hypertension was a systolic pressure of 140 to less than 160. And Stage II was a systolic pressure equal to or greater than 160.

Systolic pressure, which is the top number in a blood pressure reading, is the pressure in the arteries when the heart beats. 

Of these 2,677 visits, 20 percent of the systolic readings were normal, 45 percent were prehypertensive, 32 percent qualified as Stage I and 11 percent qualified as Stage II.

A total of 23 percent of RA visits talked about hypertension. Even in patients with systolic readings of 160 or more, only 25 percent discussed hypertension during their visit with a rheumatologist.

Having Stage II hypertension did not significantly increase the likelihood of a discussion about hypertension during a rheumatology visit compared to having Stage I hypertension. However, the likelihood of talking about hypertension at a rheumatology visit was higher for both Stage I and Stage II readings than for those people who had normal blood pressure or prehypertension.

Active tobacco users were least likely to have hypertension discussions.

The researchers wrote that these findings reveal lost opportunities for identifying and managing cardiovascular disease risks.

This study was presented at the American College of Rheumatology's annual meeting. The authors disclosed no conflicts of interest.

Review Date: 
October 31, 2013
Last Updated:
November 1, 2013