Hypertension is a risk factor for rheumatoid arthritis, yet most doctors not addressing it.

A team of U.S. researchers say that less than 1 in 3 rheumatologists discuss blood pressure with their patients who have uncontrolled hypertension. Despite the fact that patients with rheumatoid arthritis (RA) are 60 percent more at risk for cardiovascular disease (CVD) than the average person and hypertension is a modifiable risk factor, they are around “30 percent less likely to have hypertension diagnosed.”

RA is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible joints.

In a poster presentation at the recent 2013 American College of Rheumatology (ACR)/ARHP Annual Meeting, the researchers explained that they had set out to “examine the frequency and predictors of documented hypertension communication during rheumatology visits for RA patients with undiagnosed and/or uncontrolled hypertension.”

They studied the electronic health records of identified RA patients who had uncontrolled or undiagnosed hypertension and who had encounters at 1 of 3 rheumatology clinics from 2004-2011. They examined rheumatology clinic notes from first date hypertension could have been diagnosed/controlled until the date hypertension was controlled or end of data. They also considered the frequency and predictors of any hypertension communication beyond vital sign documentation as well as the impact of systolic BP stage at a rheumatology visit on the “predicted probability of hypertension communication.”

Among 1267 RA patients, 501 had uncontrolled hypertension, 232 of those lacked a hypertension diagnosis. Overall, only 23 percent of RA visits contained any hypertension communication. Even for patients whose systolic blood pressure was over 60 mmHg, only 25 percent of visits contained hypertension communication. Interestingly, active tobacco users were least likely to have hypertension communication.

The researchers concluded that despite higher CVD risk, many RA patients had undiagnosed or uncontrolled hypertension. Even with systolic BPs ≥160 mmHg, only 1 in 4 rheumatology encounters documented communication about hypertension, “demonstrating lost opportunities for identifying and managing modifiable CVD risks.” They stressed that future research should investigate “patient and provider role perceptions and other barriers and facilitators of hypertension management to systematically improve CVD prevention in RA patients.”

 

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