Аrterial hypertension in patients with ankylosing spondylitis (Bechterev’s disease) and psoriatic arthritis

Objective. The purpose of this work is evaluation of the occurrence of arterial hypertension (HTN) in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Design and methods. We enrolled 159 patients with AS and 85 with PsA in a cross-sectional study. Another aim was the analysis of the results of a 10‑year prospective study with evaluation of new- onset HTN in patients with AS (n = 278) and PsA (n = 109). Control group was formed by 150 healthy volunteers. All the results were adjusted by cardiovascular risk factors.

Results. HTN occurred in 48,7 % of AS and 67,5 % PsA patients, respectively (p = 0.03). The relative risk (RR) of HTN occurrence in patients with AS compared with healthy individuals was 2.22 (95 % CI 1.59–3.1), the odds ratio (OR) was 3.34 (95 % CI 2.1–5.3). The HTN risk in patients with PsA compared to individuals without spondyloarthritis (RR) was 3.08 (95 % CI 2.19–4.03). HTN occurrence differed significantly in PsA and AS patients (p < 0.0001).

Conclusions. The risk of new onset HTN in patients with AS and PsA is higher compared to the healthy individuals. The HTN incidence in PsA patients is higher than in the AS group. The number of new cases of HTN increases with time, and 10 years after diagnosis was verified, half of AS/PsA patients without cardiovascular disease are at risk of HTN.

1. Фоломеева О. М., Галушко Е. А., Эрдес Ш. Ф. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научно-практическая ревматология. 2008;4;4–13. [Folomeeva OM, Galushko EA, Erdes ShF. The prevalence of rheumatic diseases in populations of the adult population of Russia and the United States. Nauchnoprakticheskaya Revmatologiya = Scientific and Practical Rheumatology. 2008;4:4– 13. In Russian].

2. Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167–2172.

3. Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Рatients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med. 2015;163(6):409–416.

4. Ребров А. П., Гайдукова И. З., Поддубный Д. А. Кардиоваскулярная патология у больных анкилозирующим спондилитом. Научно-практическая ревматология. 2012;2:100–105. [Rebrov AP, Gaidulova IZ, Poddubnyi DA. Cardiovascular disease in patients

5. with ankylosing spondylitis. Nauchno-prakticheskaya Revmatologiya = Scientific and Practical Rheumatology. 2012;2:100–105. In Russian].

6. Heslinga SC, Van den Oever IA, Van Sijl AM, Peters MJ, Van der Horst-Bruinsma IE, Smulders YM et al. Cardiovascular risk management in patients with active ankylosing spondylitis: a detailed evaluation. BMC Musculoskelet Disord. 2015;16:80.

7. Brophy S, Cooksey R, Atkinson M, Zhou SM, Husain MJ, Macey S et al. No increased rate of acute myocardial infarction or stroke among patients with ankylosing spondylitis-a retrospective cohort study using routine data. Semin Arthritis Rheum. 2012;42 (2):140–145.

8. Гайдукова И. З., Ребров А. П., Лебединская О. А., Акулова А. И., Апаркина А. В. Кардиоваскулярная заболеваемостьи смертность при анкилозирующем спондилите и псориатическом артрите — результаты одноцентрового четырехлетнего наблюдения. Практическая медицина. 2015;2(88):123–129. [Gaidukova IZ, Rebrov AP, Lebedinskaya OA Akulova AI, Aparkina AV. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis — the results of a single-site fouryear follow-up. Prakticheskaya Meditsina = Practical Medicine. 2015;2(88):123–129. In Russian].

9. Sundström B, Johansson G, Johansson I, Wållberg-Jonsson S. Modifiable cardiovascular risk factors in patients with ankylosing spondylitis. Clin Rheumatol. 2014;33(1):111–7. doi: 10.1007/s10067–013–2410–4

10. Berg IJ, Semb AG, van der Heijde D, Kvien TK, Hisdal J, Olsen IC et al. Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a crosssectional study. Semin Arthritis Rheum. 2014;44(3):309–313.

11. Поддубный Д. А., Ребров А. П. Традиционные и новые факторы риска развития сердечно-сосудистых заболеваний у больных анкилозирующим спондилитом (болезнь Бехтерева). Тер. арх. 2007;79(5):20–24. [Poddubnyi DA, Rebrov AP. Traditional and new risk factors for cardiovascular disease in patients with ankylosing spondylitis (ankylosing spondylitis). Ther Archiv. 2007;79(5):20–24. In Russian].

12. Brooks WB, Jordan JS, Divine GW, Smith KS, Neelon FA. The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile. Med Care. 1990;28 (9):793–804.

13. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27 (4):361–368.

14. Taylor WI, Gladman D, Helliwell P, Marchesoni A, Mease P. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665–2673.

15. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. New approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286–2291.

16. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J et al. Assessment of Spondyloarthritis international Society. Development of an ASAS endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68 (1):18–24.

17. Wells G, Becker JC, Teng J, Dougados M, Schiff M, Smolen J, Aletaha D et al. Validation of the 28‑joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C‑reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis. 2009;68(6):954–960. doi: 10.1136/ard.2007.084459

18. Реброва О. Ю. Статистический анализ медицинских данных. М.: Медиасфера, 2002. 312 c. [Rebrova OY. Statistical analysis of medical data. The application package Statistica applications. Moscow: Social Sphere, 2002. P. 312. In Russian].

19. Heredia E, Zhu B, Lefevre C, Wang M, Barrett A, Bushe CJ et al. Prevalence and ncidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink. Edson J Eur Acad Dermatol Venereol. 2015;29(5):955–963.

20. Favarato MH, Mease P, Gonçalves CR, Gonçalves Saad C, Sampaio-Barros PD, Goldenstein-Schainberg C. Hypertension and diabetes significantly enhance the risk of cardiovascular disease in patients with psoriatic arthritis. Clin Exp Rheumatol. 2014;32 (2):182–187.

21. Ребров А. П., Гайдукова И. З. Повреждение эндотелия и жесткость сосудистой стенки у больных псориатическим артритом. Саратовский научно-медицинский журнал. 2009;5 (4):544–548. [Rebrov AP, Gaydukova IZ. Endothelium damage and arterial rigidity in patients with psoriatic arthritis. Saratovskiy Nauchno-meditsinckij Zhurnal = Saratov Scientific and Medical Journal. 2009;5(4):544–48. In Russian].

22. Ребров А. П., Никитина Н. М., Гайдукова И. З. Факторы риска развития сердечно- сосудистых заболеваний при псориатическом и ревматоидном артритах. Тер. арх. 2011;83(5): 20–24. [Rebrov AP, Nikitina NM, Gaidukova IZ. Cardiovascular risk factors in psoriatic and rheumatoid arthritis Ther Arch. 2011;83 (5):20–24. In Russian].

23. Arida A, Protogerou AD, Konstantonis G, Konsta M, Delicha EM, Kitas GD et al. Subclinical atherosclerosis is not accelerated in patients with ankylosing spondylitis with low disease activity: new data and metaanalysis of published studies. J Rheumatol. 2015;42(11):2098–2105.

24. Гайдукова И. З., Маслянский А. Л., Полянская О. Л., Колесова Е. П., Ребров А. П., Конради А. О. Жесткость сосудистой стенки у пациентов с анкилозирующим спондилитом (результаты многоцентрового исследования). Клиницист. 2015;9(3):28– 33. [Gaydukova IZ, Maslyansky AL, Polyanskaya OL, Kolesova EP, Rebrov AP, Konradi AO Vascular wall stiffness in patients with ankylosing spondylitis: results of a multicenter study. Clinitsist = The Clinician. 2015;9(3):28–33. In Russian].

25. Маслянский А. Л., Звартау Н. Э., Колесова Е. П., Васильева Е. Ю., Мазуров В. И., Конради А. О. Оценка функционального состояния эндотелия у больных ревматологическими заболеваниями. Артериальная гипертензия. 2015;21(2):168– 180. [Maslyansky AL, Zvartau NE, Kolesova EP, Vasilieva E, Mazurov VI, Konradi AO. Evaluation of endothelial function in patients with rheumatic diseases. Arterial’naya Gipertenziya = Arterial Hypertension. 2015;21(2):168–180. In Russian].

26. Eder L, Thavaneswaran A, Chandran V, Cook R, Gladman DD. Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis. Ann Rheum Dis. 2015;74(10):1830–1835.

27. Ljungman C, Kahan T, Schiöler L, Wettermark B, Boström KB, Hasselström J et al. 7b.02: the association between non-steroidal anti-inflammatory drugs and blood pressure control in hypertensive patients and the relation to gender. J Hypertens. 2015;33 Suppl 1: e92.

28. Tsai WC, Ou TT, Yen JH, Wu CC, Tung YC. Long-term frequent use of non-steroidal anti- inflammatory drugs might protect patients with ankylosing spondylitis from cardiovascular diseases: a nationwide case-control study. PLoS One. 2015;10(5): e0126347.

29. Гайдукова И. З., Ребров А. П., Хондкарян Э. В., Апаркина А.В Эффективность и кардиоваскулярная безопасность амтолметин гуацила в лечении больных анкилозирующим спондилитом (болезнь Бехтерева): окончательные результаты исследования Корона Фарматека. 2016;7:53–58. [Gaidukova OF, Rebrov AP, Khondkaryan EV, Aparkina AV. Efficacy and cardiovascular safety of amtolmetin guacil in the treatment of patients with ankylosing spondylitis: final results of Korona study. Farmateka. 2016;7:53– 58. In Russian].

30. Maslyanskiy AL, Lapin SV, Kolesova EP, Penin IN, Cheshuina MD, Feist E et al. Effects of rituximab therapy on elastic properties of vascular wall in patients with progressive systemic sclerosis. Clin Exp Rheumatol. 2014;32(6 Suppl 86):228.