From the Divisions of Clinical Pharmacology and Rheumatology, Departments of Medicine and Pharmacology; Department of Biostatistics; Vanderbilt University, Nashville, Tennessee, USA.
J Rheumatol. 2013 Nov;40(11):1806-11. doi: 10.3899/jrheum.130394. Epub 2013 Sep 1.
Hypertension (HTN), a common modifiable cardiovascular risk factor, is more common in patients with rheumatoid arthritis (RA), but the underlying mechanisms are unclear. We examined the hypothesis that mediators of inflammation and markers of cardiovascular risk are associated with HTN in RA.
We compared measures of inflammation [serum C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), homocysteine, and leptin concentrations] and insulin resistance [homeostasis model assessment index (HOMA)] in RA patients with (n = 90) and without HTN (n = 79). HTN was defined as blood pressure ≥ 140/90 mm Hg or treatment with antihypertensive therapy. The independent association of markers of interest with HTN was examined using multivariable logistic regression.
Patients with HTN were significantly older and had longer disease duration than those without HTN (both p < 0.001). Concentrations of homocysteine [11.1 (8.5-13.5) μmol/l vs 9.3 (7.8-11.0) μmol/l] were significantly higher in patients with HTN (p < 0.001). After adjustment for age, sex, race, smoking, body mass index, and corticosteroid and nonsteroidal antiinflammatory drugs (NSAID) use, increased concentrations of homocysteine (OR 2.9, 95% CI: 1.5-5.5, p = 0.001), and leptin (OR 2.0, 95% CI: 1.0-3.8, p = 0.046) were significantly associated with HTN, but the 28-joint Disease Activity Score, IL-6, CRP, TNF-α, and HOMA index were not (all p > 0.05).
HTN in patients with RA is not associated with generalized systemic inflammation or insulin resistance, but is associated with increasing concentrations of homocysteine and leptin. The pathogenesis of HTN in RA may involve pathways more regularly associated with fat and vascular homeostasis.
高血压（HTN）是一种常见的可改变的心血管危险因素，在类风湿关节炎（RA）患者中更为常见，但潜在机制尚不清楚。我们检验了这样一个假设，即炎症介质和心血管风险标志物与 RA 中的 HTN 相关。
我们比较了高血压（n = 90）和无高血压（n = 79）RA 患者的炎症指标[血清 C 反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素 6（IL-6）、同型半胱氨酸和瘦素浓度]和胰岛素抵抗[稳态模型评估指数（HOMA）]。高血压定义为血压≥140/90mmHg 或接受降压治疗。使用多变量逻辑回归检查感兴趣标志物与高血压的独立关联。
高血压患者明显比无高血压患者年龄更大且疾病持续时间更长（均 p < 0.001）。高血压患者的同型半胱氨酸浓度[11.1（8.5-13.5）μmol/l 比 9.3（7.8-11.0）μmol/l]显著升高（p < 0.001）。在校正年龄、性别、种族、吸烟、体重指数以及皮质类固醇和非甾体抗炎药（NSAID）使用后，同型半胱氨酸浓度升高（OR 2.9，95%CI：1.5-5.5，p = 0.001）和瘦素（OR 2.0，95%CI：1.0-3.8，p = 0.046）与高血压显著相关，但 28 关节疾病活动评分、IL-6、CRP、TNF-α 和 HOMA 指数无显著相关性（均 p > 0.05）。
RA 患者的高血压与全身性炎症或胰岛素抵抗无关，而与同型半胱氨酸和瘦素浓度的升高有关。RA 中高血压的发病机制可能涉及与脂肪和血管稳态更相关的途径。
