Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada.
Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada; Department of Family Medicine, The University of Western Ontario, London, Canada; Lawson Health Research Institute, London, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
Autoimmun Rev. 2021 Apr;20(4):102786. doi: 10.1016/j.autrev.2021.102786. Epub 2021 Feb 18.
Rheumatoid arthritis is frequently associated with hypertension, which has been shown to increase the risk of cardiovascular disease in these patients. The aim of this systematic review was to explore demographic, behavioural or clinical factors including medication use, associated with incident hypertension in rheumatoid arthritis.
MEDLINE and Scopus were searched for eligible studies that longitudinally investigated incident hypertension or changes in blood pressure (BP) in rheumatoid arthritis patients. Publications were screened by two reviewers according to predetermined inclusion and exclusion criteria. The quality of included studies was assessed via the Newcastle Ottawa Scale and Cochrane Risk of Bias Tool.
Fourteen studies were deemed eligible and included in this review. The proportion of female subjects ranged from 12 to 87% and the mean age ranged from 47 to 61 years. Regular exercise was associated with a decrease in systolic BP, p = 0.021. Methotrexate was associated with decreased risk of hypertension in two studies. LEF was associated with increased BP in two studies. COX-2 inhibitors were associated with systolic BP and diastolic BP variability (p = 0.009, 0.039, respectively) in one study. Prednisone was found to increase BP and risk of hypertension in three studies. The risk of hypertension in patients taking biologic disease modifying anti-rheumatic drugs (DMARDs) is unclear as some studies report increased BP while others report no difference for biologic compared to conventional DMARDs.
Despite limited longitudinal studies exploring this topic, methotrexate and exercise were shown to protect against risk of hypertension in RA patients, while prednisone and COX-2 inhibitors may increase risk of hypertension.
类风湿关节炎常伴有高血压，这已被证明会增加这些患者患心血管疾病的风险。本系统综述的目的是探讨包括药物使用在内的人口统计学、行为或临床因素与类风湿关节炎患者发生高血压的关系。
在 MEDLINE 和 Scopus 上搜索了符合条件的研究，这些研究对类风湿关节炎患者的高血压或血压变化进行了前瞻性研究。根据预先设定的纳入和排除标准，由两名评审员筛选出版物。使用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险工具评估纳入研究的质量。
确定了 14 项符合条件的研究纳入本综述。女性患者的比例范围为 12%至 87%，平均年龄为 47 岁至 61 岁。有规律的运动与收缩压降低相关，p=0.021。有两项研究表明甲氨蝶呤与降低高血压风险相关。有两项研究表明来氟米特与血压升高相关。在一项研究中，COX-2 抑制剂与收缩压和舒张压变异性相关（p=0.009，0.039）。有三项研究表明泼尼松会增加血压和高血压风险。服用生物疾病修饰抗风湿药物（DMARDs）的患者发生高血压的风险尚不清楚，因为一些研究报告血压升高，而另一些研究则报告生物 DMARDs 与传统 DMARDs 相比没有差异。
尽管有关于该主题的有限的纵向研究，但甲氨蝶呤和运动被证明可预防类风湿关节炎患者高血压的风险，而泼尼松和 COX-2 抑制剂可能会增加高血压的风险。
