papers

Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care

Arthritis Care Res

Department of Medicine, Rheumatology Division, University of Wisconsin, Madison, WI, USA

OBJECTIVE: Despite numerous studies reporting increased cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), the impact of RA on managing modifiable CVD risk factors remains understudied. We tested the hypothesis that RA is a risk factor for not receiving a hypertension diagnosis.

METHODS: Using a cohort design, we studied adult patients with and without RA/inflammatory arthritis from a large academic multispecialty practice. All were seen regularly in primary care and met clinical guideline hypertension criteria but lacked prior hypertension diagnosis/treatment. The primary outcome was time to ICD-9 code for hypertension or elevated blood pressure, or antihypertensive medication prescription. Kaplan Meier (KM) Survival and Cox proportional hazard modeling were used to examine the impact of RA on diagnosis of hypertension.

RESULTS: Among 14,974 patients with undiagnosed hypertension, 201 patients had RA codes. RA patients had equivalent primary care visits and more total visits compared to patients without RA. At study end the likelihood of hypertension diagnosis was 36% in RA patients compared to 51% without RA. In adjusted Cox models, RA patients had 29% lower hypertension diagnosis hazard [Hazard Ratio 0.71, 0.55-0.93], reflecting more undiagnosed hypertension than with other comorbidities.

CONCLUSION: Among patients meeting guideline-based hypertension criteria, RA patients were less likely to be diagnosed despite more visits than those without RA. Given heightened CVD risks in RA, and the importance of hypertension diagnosis as a first step toward controlling risk, rheumatologists should collaborate to improve rates of diagnosis for this modifiable CVD risk factor.

PMID: 24585741