INFLAMMATION IS ASSOCIATED WITH INCIDENT HYPERTENSION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A LONG-TERM FOLLOW-UP STUDY

BackgroundAxial spondyloarthritis (axSpA) patients have increased risks of developing cardiovascular diseases (CVD) compared to the general population. Hypertension (HT) as the most common CV risk factor in these patients. Whether chronic, low-grade inflammation predispose to the development of incident hypertension in axSpA remained uncertain.ObjectivesTo examine the association between markers of systemic inflammation and incident hypertension in axSpA patients.MethodsA cohort analysis was performed in patients with axSpA who had been followed since January 2001. Patients diagnosed with hypertension and/or on anti-hypertensives at baseline were excluded. The primary outcome was first diagnosis of HT occurring between January 2001 and December 2020. Three different CVD risk scores including Framingham risk score (FRS), QRISK3 and SCORE were computed at baseline. Baseline demographic data and clinical inflammatory and disease activity parameters were assessed using Cox proportional hazard regression. The association between disease activity measures, inflammatory markers, medications, and the occurrence of incident HT was assessed using time-varying Cox proportional hazard models after adjusting for baseline CVD risk scores.Results413 patients [34(25-43) years, male: 319 (77.2%)] were recruited. After a median follow up of 12 (6-17) years, 58 patients (14%) developed incident HT (IHT+group). In baseline multivariable Cox regression analysis, ESR and CV risk scores were significantly associated with developing IHT (p<0.05) (Table 1). Using time-varying multivariate analysis, higher inflammatory burden (ESR≥20) was significantly associated with developing IHT after adjusting for FRS and SCORE respectively. Use of csDMARDs was significantly linked to develop IHT after adjusting for baseline FRS, while a trend suggesting that csDMARDs was associated with an increased risk of IHT after adjusting for baseline SCORE was observed (Table 2).Table 1.Multivariable analysis with Cox proportional hazard regression for the baseline predictors of incident HT.Model 1Model 2HR (95%CI)p-valueHR (95%CI)P-valueBASDAI≥51.44 (0.78, 2.67)0.2441.39 (0.75, 2.59)0.3ESR1.01 (1.00, 1.02)0.003*1.01 (1.00, 1.02)0.003*BASFI1.03 (1.00, 1.02)0.6161.03 (0.92, 1.16)0.572Baseline disease duration1.04 (1.00, 1.08)0.1021.03 (0.98, 1.08)0.215Symptom duration1.01 (0.98, 1.05)0.5131.02 (0.98, 1.05)0.386FRS1.05 (1.03, 1.08)<.001*SCORE1.23 (1.12, 1.36)<.001*Table 1b.Model 1Model 2HR (95%CI)p-valueHR (95%CI)P-valueBASDAI≥61.53 (0.84, 2.78)0.1661.47 (0.81, 2.69)0.209ESR1.01 (1.00, 1.02)0.003*1.01 (1.00, 1.02)0.003*BASFI1.03 (0.92, 1,15)0.6461.03 (0.92, 1.16)0.599Baseline disease duration1.04 (1.00, 1.08)0.1211.03 (0.98, 1.07)0.244Symptom duration1.01 (0.98, 1.05)0.5301.02 (0.98, 1.05)0.391FRS1.05 (1.03, 1.08)<.001*SCORE1.23 (1.11, 1.35)<.001*ConclusionHigher baseline and time-varying inflammatory burden predict the development of IHT in addition to traditional CV risk scores in axSpA patients. While exposure to csDMARDs may be associated with the development of IHT, NSAIDs and biologic DMARDs use were not associated with the development of IHT.References[1]Exarchou, S., et al., Mortality in ankylosing spondylitis: results from a nationwide population-based study. Ann Rheum Dis, 2016. 75(8): p. 1466-72.Table 2.Multivariable analysis with Cox proportional hazard regression for the time-dependent predictors of incident HT.Table 2a.Model 1Model 2Time-dependent HR (95%CI)p-valueTime-dependent HR (95%CI)P-valueESR1.01 (1.00, 1.03)0.0851.01 (1.00, 1.03)0.074csDMARDs2.24 (1.04, 4.82)0.04*2.16 (1.00, 4.68)0.05FRS1.05 (1.01, 1.08)0.008*SCORE1.24 (1.09 1.41)0.001*Table 2b.Model 1Model 2Time-dependent HR (95%CI)P-valueTime-dependent HR (95%CI)P-valueESR≥202.22 (1.05, 4.72)0.038*2.27 (1.06,4.82)0.034*csDMARDs2.17 (1.01, 4.64)0.047*2.09 (0.97, 4.50)0.059FRS1.05 (1.01, 1.08)0.01*SCORE1.23 (1.08, 1.41)0.002*Disclosure of InterestsNone declared