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High Blood Pressure and Rheumatoid Arthritis: What’s the Connection?

Posted on January 18, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Elizabeth Wartella, M.P.H.

People with rheumatoid arthritis (RA) have an increased risk of high blood pressure, also called hypertension. The two conditions are comorbidities, meaning they commonly occur together. Large research studies have found the prevalence of hypertension in people with RA ranges from 52 percent to 73 percent.

A study published in the Journal of Rheumatology found that people with RA were at a significantly increased risk of having hypertension as compared to a general population of people without RA. Although there is a connection between RA and hypertension, not everyone with RA will have high blood pressure.

Members of myRAteam have commented about also having high blood pressure. One member wrote, “Over the past year, I have been having high blood pressure even though I am still young.” Another said, “The past few weeks, I’ve been battling flare-ups and extremely high blood pressure.”

If you have RA and high blood pressure, talk to your health care practitioner or rheumatologist about how to manage and treat both conditions. Once detected, high blood pressure can be controlled, and it doesn’t always require treatment. This article discusses the connection between the two conditions and provides ideas for managing both.

The Connection Between RA and High Blood Pressure

RA is usually diagnosed after symptoms like swelling and discomfort in joints become so painful that the person seeks medical or specialized rheumatology care. High blood pressure, however, may not produce obvious or noticeable symptoms.

Blood pressure is usually tested at regular doctor’s appointments. The reading is in millimeters of mercury (mmHg) and provides two numbers:

  • Systolic blood pressure (the top number) — Measures blood pressure in your arteries when your heart beats
  • Diastolic blood pressure (the bottom number) — Measures blood pressure in your arteries when your heart is at rest (between beats)

Sometimes, people are diagnosed with high blood pressure shortly after getting diagnosed with RA. Several factors may be responsible for the connection between high blood pressure and RA. Inflammation, RA medications, and physical inactivity due to RA are thought to play a part in this relationship.

Inflammation

RA is both an autoimmune and inflammatory disease because the immune system attacks healthy cells in the body and this process causes inflammation. Inflammation in the body is measured through levels of C-reactive protein (CRP), which is a protein made by the liver. Some research studies have found higher levels of CRP in people with high blood pressure.

Research studies have also found inverse relationships between levels of CRP and elasticity of arteries — people with higher levels of inflammation have less elastic arteries. Inflammation can also cause atherosclerosis (a buildup of plaque in arteries), which narrows the area for blood to flow through blood vessels and arteries.

Less elastic and more narrow arteries increase blood pressure and the risk of cardiovascular disease, heart attacks, heart failure, and strokes.

Chronic inflammatory diseases like RA are associated with decreased arterial elasticity, which may provide one explanation for the connection between high blood pressure and RA.

Medications

Many different medications used to treat RA may increase the risk of high blood pressure. These medications include those that address pain and inflammation, like nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and acetaminophen.

A systematic review — a type of research study that provides a summary of other existing research — found that the nonselective NSAIDs ibuprofen and indomethacin significantly increased blood pressure over four weeks of use. Other studies found that highly selective cox-2 inhibitors (coxibs), including rofecoxib and etoricoxib, increased blood pressure in people with RA, and therefore should be avoided for treatment. Furthermore, the combined use of NSAIDs or coxibs and steroids may increase blood pressure and should be monitored if these drugs are prescribed for RA.

Studies have also found that NSAIDs may have an impact on the effectiveness of antihypertensive drugs like diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and other vasodilators. It seems that NSAIDs do not have any effect on calcium channel blockers (another type of antihypertensive drug). NSAID use for RA pain needs to be taken into consideration when determining the type of antihypertensive drug to prescribe.

Other types of drugs used to treat RA that can induce hypertension are disease-modifying antirheumatic drugs such as Arava (leflunomide), Neoral (cyclosporine), and high doses of oral glucocorticoids.

Biologic tumor necrosis factor inhibitors like Remicade (infliximab), Humira (adalimumab), and Enbrel (etanercept) may help to reduce RA inflammation without increasing the risk of hypertension or heart disease. Methotrexate is an antirheumatic drug that is currently being examined by the National Institutes of Health as an RA treatment that may even lower the risk of heart disease.

Physical Inactivity

Physical activity is often difficult for people living with RA. Symptoms of RA like joint pain, damage, and swelling often get in the way of a regular exercise routine. Many people with RA may avoid physical activity because it causes more pain and fatigue. These individuals tend to lead a sedentary lifestyle, which can lead to weight gain, obesity, and an increased risk of high blood pressure.

“My pain does not allow me to be active. I push, but the more I strive to add more movement, my pain gets stronger,” wrote one myRAteam member.

Learn about ways to exercise with RA.

Living With RA and High Blood Pressure

RA and high blood pressure may affect each other in several different ways. Symptoms of each may become present or worse at the same time, and RA medications may increase blood pressure.

RA Flares and Symptoms

When living with RA and high blood pressure, some people discover that their blood pressure is higher during RA flares. “I have found that RA and hypertension seem to go hand in hand for some people, me included. Pain levels and stress elevate my blood pressure,” wrote one myRAteam member.

In response to a myRAteam member’s question, “Does anyone’s blood pressure go up during a flare?” another member wrote, “Yes, definitely! I don’t know if my rationale is the true medical reason, but enduring the pain is stressful on both body and mind.”

There is not enough evidence to definitively state whether controlling RA disease activity helps to reduce the risk of developing high blood pressure or whether it helps to control blood pressure in those with RA.

Some myRAteam members also question whether high blood pressure can make RA symptoms and flares worse. “Can high blood pressure make my arthritis pain feel worse? My hands are more swollen, and my legs are throbbing more as my blood pressure gets higher,” wrote one member.

RA Medication

As noted above, many different RA medications may increase blood pressure and lead to hypertension. If you already have hypertension or are at an increased risk of cardiovascular events due to genetic and other lifestyle factors (like smoking), talk to your doctor about these cardiovascular risk factors when determining which RA medications you should take.

One member of myRAteam commented about having to discontinue their RA medication due to high blood pressure, saying, “I have been off of Cimzia for six weeks since my last injection, as my blood pressure has been high.”

Some people with high blood pressure will not show any signs or symptoms. If you take an RA medication that may increase your blood pressure, make sure to get regular blood pressure readings from your primary care doctor or monitor your blood pressure at home. Machines for checking your blood pressure are available online and at most pharmacies.

Managing RA and High Blood Pressure

RA and high blood pressure can be treated at the same time. RA is treated through different medications, lifestyle changes, and surgical means that all work to manage symptoms. High blood pressure, however, does not always need to be treated, though it does need to be monitored. Hypertension is considered modifiable because blood pressure can be reduced through lifestyle changes. These include:

  • Quitting smoking
  • Reducing sodium (salt) or cholesterol in your diet
  • Getting more physical activity
  • Losing weight if you are overweight
  • Limiting alcohol
  • Managing stress

In some cases, a doctor may prescribe medication to control high blood pressure, but some of those medicines may interact with RA medications. Because symptoms of RA and high blood pressure may affect each other, it’s important to manage both conditions to minimize discomfort and improve quality of life.

Talk to Others Who Understand

When managing RA and high blood pressure, joining a support group and talking about your experiences may be helpful. On myRAteam, the social network for people with RA, more than 173,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Do you have RA and high blood pressure? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. is an associate editor at MyHealthTeam. She holds a masters in public health from Columbia University. Learn more about her here.

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