A 3-year study, involving >20,000 individuals, found that certain disease-modifying therapies for rheumatoid arthritis (RA) may have a positive effect on blood pressure. 

For this study, researchers used the Veterans Affairs electronic medical record databases to identify unique dispensing of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone in order to assess the effect of these treatments on systolic and diastolic blood pressure (SBP and DBP), as well as incident hypertension among RA patients.

The analysis showed no changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation (P>.62). However, over the 6 months following initiation of treatment, there was a decline in SBP of β= −1.08  (−1.32 to −0.85; P<.0001) and DBP of β= −0.48 (−0.62 to −0.33; P<.0001).  

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The greatest BP declines were noted in patients taking methotrexate and hydroxychloroquine; those who initiated methotrexate were 9% more likely to have optimal blood pressure at 6 months. In contrast, leflunomide was tied to increases in BP, and a greater incidence of hypertension when compared to methotrexate (hazard ratio 1.53 [1.21-1.91; P<.001]). In multivariate models, sulfasalazine and hydroxychloroquine users had similar risk of incident hypertension when compared with methotrexate.

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