Do TNF-alpha Inhibitors Lower Hypertension Risk in RA Patients?

SAN FRANCISCO, CA—After adjusting for covariates like patient age and oral steroid cumulative dose, tumor necrosis factor-alpha (TNF-α) inhibitors do not reduce hypertension risk among patients diagnosed with rheumatoid arthritis (RA), according to findings reported at the 2015 ACR/ARHP Annual Meeting.

“Treatment with TNF-α inhibitors was not associated with a reduced risk of incident hypertension compared with nbDMARDs [nonbiologic disease-modifying antirheumatic drugs] in RA patients,” reported lead study author Rishi J. Desai, MD, of the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Previous, small studies had suggested that TNF-α inhibitors might lower blood pressure in RA patients, but no previous study had compared their effects with those of nbDMARDs, the new study's coauthors noted. To compare hypertension risk among patients starting TNF-α inhibitor therapy and those administered nbDMARDs, the researchers studied a cohort of patients undergoing methotrexate monotherapy for RA, without cardiovascular disease or hypertension, using insurance claims data from 2001–2012. Incident hypertension was defined as diagnosis and a prescription for an anti-hypertensive medication.

“We identified 4,822 initiations of TNF-α inhibitors and 2,400 of nbDMARDs,” the coauthors reported. “Crude incidence rates of hypertension per 1,000 person-years of follow-up were 36.1 (95% CI: 31.8–40.7) for the TNF-α inhibitor group and 41.2 (95% CI: 33.0–50.8) for the nbDMARDs. The crude [unadjusted] HR [hazard ratio] of TNF-α inhibitors versus nbDMARDs for the risk of incident hypertension was 0.85 (95% CI: 0.67–1.09).”

After statistically adjusting for baseline and time-varying covariates (including NSAIDs use, injectable steroids, cumulative dose of oral steroids, methotrexate use, leflunomide or cyclosporine use, other non-TNF biologic use, hospitalizations, emergency room visits, office visits, number of distinct drugs, and patient age), the HR rose to 1.01, however (95% CI: 0.78–1.31).

In a subsequent verification analysis, the adjusted HR of incident hypertension was 2.33 (95% CI: 1.75–3.09) in leflunomide initiators compared with methotrexate initiators, the coauthors noted.

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