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Arthritis Res Ther. 2018 Jun 1;20(1):107. doi: 10.1186/s13075-018-1597-9.

Association between inflammation and systolic blood pressure in RA compared to patients without RA.

Author information

1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
2
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
3
Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
4
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.
5
Research Computing, Partners HealthCare, Charlestown, MA, USA.
6
Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA.
7
Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
8
Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, MA, 02115, USA. kliao@bwh.harvard.edu.
9
Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. kliao@bwh.harvard.edu.

Abstract

BACKGROUND:

The relationship between inflammation and blood pressure (BP) has been studied mainly in the general population. In this study, we examined the association between inflammation and BP across a broader range of inflammation observed in rheumatoid arthritis (RA) and non-RA outpatients.

METHODS:

We studied subjects from a tertiary care outpatient population with C-reactive protein (CRP) and BP measured on the same date in 2009-2010; RA outpatients were identified using a validated algorithm. General population data were obtained from the National Health and Nutrition Examination Survey (NHANES) as comparison. To study the cross-sectional association between CRP and BP in the three groups, we constructed a generalized additive model. Longitudinal association between CRP and BP was examined using a repeated-measures linear mixed-effects model in RA outpatients with significant change in inflammation at two consecutive time points.

RESULTS:

We studied 24,325 subjects from the outpatient population, of whom 1811 had RA, and 5561 were from NHANES. In RA outpatients, we observed a positive relationship between CRP and systolic BP (SBP) at CRP < 6 mg/L and an inverse association at CRP ≥ 6 mg/L. A similar inverse U-shaped relationship was observed in non-RA outpatients. In NHANES, we observed a positive relationship between CRP and SBP as demonstrated by previous studies. Longitudinal analysis in RA showed that every 10 mg/L increase in CRP was associated with a 0.38 mmHg reduction in SBP.

CONCLUSIONS:

Across a broad range of CRP observed in RA and non-RA outpatients, we found an inverse U-shaped relationship between CRP and SBP, highlighting a relationship not previously observed when studying the general population.

KEYWORDS:

Blood pressure; Inflammation; Rheumatoid arthritis

PMID:
29855349
PMCID:
PMC5984318
DOI:
10.1186/s13075-018-1597-9
[Indexed for MEDLINE]
Free PMC Article

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