Monday, 4 September 2017

Is Rheumatoid Arthritis Hiding Your High Blood Pressure?

It's no secret that having rheumatoid arthritis (RA) increases your risk for heart disease, or that high blood pressure is also a heart-disease risk factor. But high blood pressure often goes untreated in those with RA.

In fact, researchers have found that having rheumatoid arthritis may actually increase the likelihood that you won’t receive a diagnosis of high blood pressure, even if you have all the signs.

That was the finding of a study published in August 2014 in Arthritis Care & Research, that followed 14,974 people who met the criteria for high blood pressure, or hypertension, but had never been diagnosed with it. In that group, 201 people had RA. By the end of the study, which lasted four years, the likelihood of getting a diagnosis of high blood pressure was just 36 percent for those with RA, compared with 51 percent for people who didn't have RA.

Why Doctors Don't Always Diagnose, Treat High Blood Pressure

“All [of] the patients were in the same health care system, and they all had equivalent numbers of primary care visits," says Christie M. Bartels, MD, the study's lead author and a rheumatologist at the University of Wisconsin School of Medicine and Public Health in Madison. "But repeatedly abnormal blood pressure readings were less likely to lead to a diagnosis of high blood pressure or treatment of high blood pressure in patients with RA."

“Many studies have confirmed that having RA increases the risk for cardiovascular disease by 50 to 60 percent," Dr. Bartels says. "But even when people with RA had three blood pressure readings over 140/90, or two readings of 160/100, [a] diagnosis was less likely to be made."

It is hard to know why hypertension is missed in people with RA, but "it may be due to a phenomenon we call diagnostic overshadowing," she says. "Doctors tend to pay more attention to the primary disease and overlook other problems." It could also be that primary care doctors and rheumatologists are not communicating.

The Link Between Rheumatoid Arthritis and Blood Pressure

RA is an inflammatory disease that affects blood vessels as well as joints. “There is an increased inflammatory burden on the vascular system," Bartels explains. "Plaques that form inside blood vessels form at an earlier age and contribute to heart disease and high blood pressure."

According to the Arthritis Foundation, having RA doubles your risk for cardiovascular diseases. Other reasons for the increased risk include:

High cholesterol, which is also commonly overlooked in RA
Inactivity, which can lead to obesity and poor vascular health
RA medications, such as NSAIDs or steroids, that can affect blood vessels
Do You Have High Blood Pressure?

Just because doctors are missing the boat on high blood pressure and RA doesn’t mean you have to.

“This is one of those situations where patients need to empower themselves and take charge of their own health care," Bartels says. "High blood pressure is called a silent killer because it rarely causes symptoms. That means you need to know your blood pressure numbers."

You may face an increased risk of eventually developing high blood pressure if your systolic blood pressure number (the top one) is above 120 and the diastolic (lower) number is above 80. Ask your doctor what your numbers are, and talk about your risk for high blood pressure.

Lowering Disease Risks When You Have RA

Lowering your risk for high blood pressure when you have RA is not much different than it is for people who don't have RA, with one exception. Because having RA means there's more inflammation in your body, you really need to work with your doctor to get your RA under the best control possible. Here's how:

  • Lose weight if you need to and then maintain a healthy weight.
  • Get regular exercise — try some water aerobics if your joints are sore.
  • Maintain a healthy diet.
  • Get your cholesterol under control.
  • Cut back on salt.
  • Cut back on alcohol.
  • Don’t smoke.
  • Find ways to avoid and manage stress.

If you have RA, be aware of the dangers of high blood pressure and heart disease. High blood pressure increases your risk for heart attack and stroke. Don’t assume everything is okay if your doctor doesn’t say anything: High blood pressure usually occurs without any symptoms. You need to ask what your blood pressure numbers are and pin down your doctor about your risk. Taking an active role in your health care is the way to go.

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