Department of Rheumatology, C-01-R, Leiden University Medical Center, P O Box 9600, Leiden 2300 RC, The Netherlands.
Ann Rheum Dis. 2010 Jul;69(7):1342-5. doi: 10.1136/ard.2009.124180. Epub 2010 May 14.
To evaluate the effect of disease activity and antirheumatic treatment on blood pressure (BP) in patients with recent-onset rheumatoid arthritis (RA).
508 patients with RA were randomised to receive (1) sequential monotherapy, (2) step-up combination therapy, (3) initial combination with prednisone or (4) with infliximab. Systolic and diastolic BP (SBP, DBP), disease activity score (DAS) and body mass index (BMI) were evaluated every 3 months. A linear mixed model was used to model SBP and DBP in each treatment group during year 1, adjusting for baseline BP, changes in BMI, DAS and cardiovascular medication.
In all groups, mean SBP and DBP were lower for patients with DAS < or =2.4 than for patients with DAS >2.4. In addition, patients initially treated with infliximab (group 4) had a larger decrease in SBP and DBP over time than patients in groups 1-3. The decrease in BP was also observed in patients treated with infliximab after failure on conventional disease-modifying antirheumatic drugs in groups 1-3. The decrease in BP associated with treatment with infliximab occurred irrespective of the DAS response.
A lower DAS is associated with lower BP. An additional decrease in BP was observed in patients treated with infliximab. Further research is needed to confirm the effect of infliximab on BP.
评估疾病活动度和抗风湿治疗对新发类风湿关节炎（RA）患者血压（BP）的影响。
将 508 例 RA 患者随机分为（1）序贯单药治疗，（2）逐步联合治疗，（3）联合泼尼松初始治疗或（4）联合英夫利昔单抗治疗。每 3 个月评估一次收缩压（SBP）和舒张压（DBP）、疾病活动评分（DAS）和体重指数（BMI）。采用线性混合模型，对第 1 年每个治疗组的 SBP 和 DBP 进行建模，调整基线 BP、BMI、DAS 和心血管药物的变化。
在所有组中，DAS≤2.4 的患者的平均 SBP 和 DBP 均低于 DAS>2.4 的患者。此外，与组 1-3 相比，初始接受英夫利昔单抗（组 4）治疗的患者 SBP 和 DBP 随时间的下降幅度更大。在组 1-3 中，对常规疾病修饰抗风湿药物治疗失败的患者，使用英夫利昔单抗治疗后也观察到 BP 的下降。与英夫利昔单抗治疗相关的 BP 下降与 DAS 反应无关。
较低的 DAS 与较低的 BP 相关。接受英夫利昔单抗治疗的患者观察到 BP 进一步下降。需要进一步研究以确认英夫利昔单抗对 BP 的影响。
