Inflammation is associated with incident hypertension in patients with axial spondyloarthritis: A longitudinal cohort study

ABSTRACT

Objectives

To elucidate the risk factors for the development of incident hypertension (IHT) in patients with axial spondyloarthritis (axSpA).

Methods

We conducted a retrospective cohort study in axSpA patients who were recruited from 2001 to 2019 from a university clinic in Hong Kong. Patients with HT and/or anti-hypertensive drug use at baseline were excluded. They were followed until the end of 2020. The outcome was IHT, defined by a diagnosis and a prescription for an antihypertensive drug. Baseline and time-varying Cox regression analyses adjusting for age, sex, and body mass index (BMI), were used to assess the relationship between drug use, inflammatory burden, and IHT.

Results

Four hundred and thirteen patients [age: 34(25–43) years, male: 319 (77.2%)] were recruited. After a median follow-up of 12 (6–17) years, 58 patients (14%) developed IHT (IHT+group). Among all the baseline variables, disease duration and delay in diagnosis were the independent predictors for IHT based on the Cox regression model. In the multivariate Cox regression analysis, baseline disease duration, delay in diagnosis and time-varying ESR levels were independent predictors associated with an increased risk of IHT. IHT risk was significantly increased in patients with disease duration >5 years. The use of anti-inflammatory drugs was not associated with the development of IHT.

Conclusion

Higher inflammatory burden as reflected by a longer disease duration, delay diagnosis and higher ESR levels, were predictors associated with IHT after adjusting for traditional CV risk factors. These data support routine screening for hypertension in axSpA patients, especially those with longer disease duration.

KEY MESSAGES

What is already known about this subject?

• Patients with axial spondyloarthritis (axSpA) have a higher risk of cardiovascular (CV) disease compared with the general population. Hypertension (HT) is one of the most important modifiable risk factors. Whether increased inflammatory pathways or the use of anti-inflammatory therapies contribute toward the increased prevalence of HT in axSpA remained controversial.

What does this study add?

• First, higher inflammatory burden as reflected by a longer baseline disease duration, delay in diagnosis and higher ESR levels were predictors of incident HT (IHT) after adjusting for traditional CV risk factors in axSpA. Second, IHTrisk was significantly increased in pati\ents with disease duration >5 years.

How might this impact on clinical practice or future developments?

• Early diagnosis and adequate control of systematic inflammation may be important to prevent the development of HT. Routine screening for hypertension in axSpA patients should be considered, especially in patients with longer disease duration.

KEYWORDS:

• Axial spondyloarthritis
• incident hypertension
• cardiovascular disease

Acknowledgments

We would like to show our gratitude to all medical staffs, research assistants. Furthermore, we would like to thank all the support from family members.

Disclosure statement

No potential conflict of interest was reported by the authors.

Contributors

All authors critically revised the manuscript for important intellectual content. Specific roles included: study design (LS Tam, LH Shi, Steven Lam), data collection (LS Tam, H So, Tena Li, LH Shi, Steven Lam). Data analysis (LH Shi, Steven Lam, Crystal Chan), drafting of manuscript (LH Shi, LS Tam).

The Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (No. 2020. 519). Written informed consent was waived.

Patient and publicinvolvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.