Takeaway
- Cumulative dose of oral glucocorticoids was associated with
increased incidence of hypertension in patients with chronic inflammatory diseases. - Chronic inflammatory diseases included inflammatory bowel disease, rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, vasculitis, and systemic lupus erythematosus.
- Findings suggest that blood pressure should be closely monitored for early identification and management of hypertension in patients with chronic inflammatory diseases treated with long-term glucocorticoids.
Study design
- This population-based study investigated the effect of oral glucocorticoid dose on incident hypertension in 71,642 patients with common chronic inflammatory diseases, using linked electronic health records from 389 practices in England during 1998–2017.
- The most common underlying condition was inflammatory
bowel disease (35.1%) and rheumatoid arthritis (28.2%). - Funding: The Medical Research Council TARGET Partnership Grant and others.
- During a median follow-up of 6.5 (interquartile range, 2.7-11.8) years, 24,896 (34.8%) patients were diagnosed with hypertension and the incidence rate was 46.7 per 1000 person-years (95% CI, 46.0-47.3).
- Incidence rates of hypertension increased with higher cumulative glucocorticoid prednisolone-equivalent dose:
- between >0.0 and 959.9 mg: from 44.4 per 1000 person-years in periods of nonuse to 45.3 per 1000 person-years (HR, 1.14; 95% CI, 1.09-1.19);
- 960–3054.9 mg: 49.3 per 1000 person-years (HR, 1.20; 95% CI, 1.14-1.27);
- ≥ 3055 mg: 55.6 per 1000 person-years (HR, 1.30; 95% CI, 1.25-1.35).
- The risk of hypertension increased with a high cumulative dose of oral glucocorticoids in all chronic inflammatory diseases, but dose-response effects were not observed for daily dose.
- Lack of data on the end date of glucocorticoid prescriptions and the daily dose during tapering periods.
References
References
