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For patients who have inflammatory autoimmune disease (IAD), the chances of being diagnosed with hypertension or cardiovascular (CV) disease are greatly increased when adjusting for other factors, say the authors of a new systematic review and meta-analysis published in Current Hypertension Reports.¹

As a result of these findings, the authors pointed to these data as the basis for advocating intensive screening and management of hypertension in patients with IAD to reduce CV morbidity and mortality.

Hypertension and CV events in patients with IADs

While increased risk of CV death and mortality has been shown across many types of IAD, previous studies have reported a range in the specific risk for individual inflammatory diseases. For example, the risk of CV events, such as myocardial infarction (MI), is more than doubled in patients with systemic lupus erythematosus (SLE) relative to the general population,² while the estimated increase in the relative risk of MI in rheumatoid arthritis (RA) patients is 68%.³ High rates of hypertension, which is one of the strongest risk factors for CV events, have been previously reported in IAD. In this new study, however, relative rates of hypertension and CV complications were evaluated across IADs.¹

After searching for controlled studies published between January 2000 and March 2022 that evaluated hypertension in relation to risk of CV complications, a meta-analysis to assess risk in SLE, RA, psoriatic arthritis (PsA) and other forms of psoriasis, and Sjogren鈥檚 syndrome (SS) was conducted.¹ Of 2726 studies screened, 122 were selected for the meta-analysis, which involved random effects and multifactor mega-regression to arrive at adjusted odds ratios (OR) of risk for each disease state. Most of the trials in the meta-analysis evaluated the prevalence of hypertension in a single disease state, but some included multiple IADs.

The numbers don鈥檛 lie

The overall unadjusted prevalence of hypertension in patients with IAD versus controls was 1.67, with a tight 95% confidence interval of 1.58 to 1.76.1 After adjustment, the OR was 1.36 (95% CI 1.24 to 1.50). Individually, all IADs were associated with a statistically significant increased OR. From highest to lowest, these OR values were 3.40 for SLE (95% CI 1.93 to 6.00), 2.02 for SS (95% CI 1.19 to 3.44), 1.49 for PsA (95% CI 1.15 to 1.94), 1.32 for other forms of psoriasis (95% CI 1.16 to 1.51), and 1.28 for RA (95% CI 1.04 to 1.58).

According to the authors of the current meta-analysis, only 1 study assessed the risk of hypertension in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. That study suggested a 28-fold increase (95% CI 1.52 to 522.75), but the authors cautioned against a conclusion about risk on the basis of a single study.

When evaluating specific CV outcomes, the authors reported the following statistically significant adjusted ORs. From highest to lowest, these were 73% for peripheral arterial occlusive disease (OR 1.73, 95% CI 1.30 to 2.32), 38% for ischemic heart disease (OR 1.38, 95% CI 1.21 to 1.57), 37% for cerebrovascular disease (OR 1.37, 95% CI 1.03 to 1.81), and 28% for heart failure (OR 1.28, 95% CI 1.05 to 1.55). 

The importance of screening

When the individual disease states were analyzed, not all of the ORs reached statistical significance, but they all moved in the same direction of increased risk.

The authors also found that the OR in patients with IAD relative to the general population was of a greater magnitude in younger patients and in those with a lower prevalence of other CV risk factors, such as diabetes and obesity, reinforcing the concept that the disease itself has an independent effect on CV risk.

According to the senior author of this study, Camille Roubille, MD, PhD, a research and clinical rheumatologist affiliated with the Department of Internal Medicine, Montpellier University, Montpellier, France, the evidence that both hypertension and CV risk is increased in IAD patients supports the importance of screening and aggressive treatment.

鈥淭here has been substantial progress in the control of these diseases, making it even more important to look at comorbidities that threaten extended survival,鈥� she told MedPage Today, adding that management of CV risk overall, and hypertension specifically, is 鈥渦rgently needed.鈥�

Published: July 30, 2024