Patients with rheumatoid arthritis (RA) are frequently treated with glucocorticoids (GCs), but evidence is conflicting about whether GCs are associated with hypertension. The aim of this study was to determine whether GCs are associated with incident hypertension in patients with RA.
A retrospective cohort of patients with incident RA and without hypertension, were identified from UK primary care electronic medical records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use, dose and cumulative dose, with a 3 month attribution window. Hypertension was identified through either: blood pressure (BP) measurements >140/90mmHg or antihypertensive prescriptions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards (PH) regression models were fitted to determine if there was an association between GC use and incident hypertension.
There were 17,760 patients in the cohort. 7,421 (42%) were prescribed GCs during follow-up. The incident rate of hypertension was 64.1 per 1000 person years (95% CI: 62.5 to 65.7). The Cox PH model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio: 1.17 (95% CI 1.10 to 1.24)). When categorised by dose, only doses above 7.5mg were significantly associated with hypertension. Cumulative dose did not indicate a clear pattern.
Recent GC use was associated with incident hypertension in patients with RA, in particular doses >=7.5mg were associated with hypertension. Clinicians need to consider cardiovascular risk when prescribing GCs and ensure BP is regularly monitored and treated where necessary.