Cui Jing, Ridker Paul M, Solomon Daniel H
Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Rheumatology (Oxford). 2025 Jun 1;64(6):3917-3920. doi: 10.1093/rheumatology/keae604.
Low-dose MTX (LD-MTX) has been associated with a reduced risk of cardiovascular disease (CVD) among patients with systemic rheumatic diseases but not among the general population. Prior reports suggest that LD-MTX may reduce blood pressure (BP). We studied the effect of LD-MTX on BP.
We examined data that compared LD-MTX to placebo in a randomized double-blind controlled clinical trial conducted among patients who had known CVD but without rheumatic disease. Systolic and diastolic BP (SBP, DBP) were collected as vital sign measurements at each scheduled study visit during 5 years of follow-up. Longitudinal SBP and DBP were compared between patients of LD-MTX and placebo arms using a linear mixed model.
Data were used from 2391 patients randomized to LD-MTX and 2395 to placebo, with a mean follow-up of 26 months. At baseline, SBP and DBP were normally distributed with similar medians [SBP: 128 mmHg (IQR 118-139), DBP: 74 mmHg (IQR 67-80)] between patients from both treatment groups; 93% patients reported at baseline using at least one type of medication for hypertension. After treatment, compared with placebo, the estimated differences in changes of SBP and DBP in the LD-MTX group were <1 mm (SBP: β = -0.75 mmHg, 95% CI -0.02 to -1.49; DBP: β = -0.56 mmHg, 95% CI -0.12 to -1.01).
Patients randomized to LD-MTX without systemic rheumatic disease had no clinically meaningful difference in BP compared with placebo.
ClinicalTrials.gov, http://clinicaltrials.gov, NCT01594333.
低剂量甲氨蝶呤（LD-MTX）与系统性风湿性疾病患者心血管疾病（CVD）风险降低相关，但在普通人群中并非如此。先前的报告表明，LD-MTX可能会降低血压（BP）。我们研究了LD-MTX对血压的影响。
我们在一项针对已知患有CVD但无风湿性疾病的患者进行的随机双盲对照临床试验中，检查了将LD-MTX与安慰剂进行比较的数据。在5年随访期间的每次预定研究访视时，收集收缩压和舒张压（SBP、DBP）作为生命体征测量值。使用线性混合模型比较LD-MTX组和安慰剂组患者的纵向SBP和DBP。
数据来自2391例随机分配至LD-MTX组和2395例随机分配至安慰剂组的患者，平均随访26个月。在基线时，两个治疗组患者的SBP和DBP呈正态分布，中位数相似[SBP：128 mmHg（四分位间距118 - 139），DBP：74 mmHg（四分位间距67 - 80）]；93%的患者在基线时报告使用至少一种高血压药物。治疗后，与安慰剂相比，LD-MTX组SBP和DBP变化的估计差异<1 mmHg（SBP：β = -0.75 mmHg，95%置信区间 -0.02至 -1.49；DBP：β = -0.56 mmHg，95%置信区间 -0.12至 -1.01）。
随机分配至LD-MTX且无系统性风湿性疾病的患者与安慰剂相比，血压无临床意义上的差异。
ClinicalTrials.gov，http://clinicaltrials.gov，NCT01594333。
