Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Epidemiology and Biostatistics


Barra, Lillian

2nd Supervisor

Stranges, Saverio



Rheumatoid arthritis (RA) patients are at higher risk for hypertension (HTN) than the general population. This study explored characteristics and risk factors associated with HTN and prevalence of HTN at RA diagnosis. A systematic review including fourteen studies found methotrexate was associated with lower risk of HTN. Corticosteroids and COX-2 inhibitors were associated with higher risk of HTN. In the Canadian Early Arthritis Cohort (N=2052), 26% were hypertensive at RA diagnosis. Logistic regression was used to explore whether several demographic, behavioural, and clinical characteristics were associated with HTN at baseline. Hypertensive subjects were older [OR=4.99 (95%CI: 3.28, 7.58)], overweight [OR=1.60 (95%CI: 1.11, 2.31)], obese [OR=2.73 (95%CI: 1.89, 3.93)], had diabetes [OR=3.50 (95%CI: 2.27, 5.40)] and hyperlipidemia [OR=2.54 (95%CI: 1.83, 3.53)]. In women, excess alcohol consumption was also associated with HTN. More longitudinal studies are needed to further understand risk of HTN throughout the course of RA disease.

Summary for Lay Audience

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Along with this inflammation, RA patients experience cardiovascular disease and cardiovascular events, such as heart attack or stroke, more often than the general population. High blood pressure, also called hypertension (HTN), is a cardiovascular risk factor and also experienced more often by RA patients than the general population. By better understanding the risk of HTN in this population, physicians can help patients to prevent HTN and therefore lower risk for cardiovascular disease or events.

This thesis was composed of two studies. The first was a review of scientific literature to explore risk factors for HTN in RA patients. This review included fourteen studies. Some antirheumatic drugs, such as methotrexate were associated with lower risk for HTN. Other anti-inflammatory drugs: corticosteroids and COX-2 inhibitors, were associated with higher risk of HTN.

The second study used data from a group of early rheumatoid arthritis patients across Canada, called the Canadian Early Arthritis Cohort. Frequency of HTN at RA diagnosis was explored, as well as which demographic, behavioural, and clinical characteristics were associated with being hypertensive at RA diagnosis. Two thousand and fifty-two RA patients were included, and 26% had HTN at study enrolment. Associated with HTN was older age, being overweight or obese, diabetes, and high cholesterol. In women, excess alcohol consumption per week was also associated with being hypertensive. In men, only older age, diabetes, and high cholesterol were associated with HTN.

In conclusion, some anti-inflammatory drugs may be risk factors for HTN in RA patients. One in four RA patients were hypertensive at RA diagnosis. Cardiovascular risk factors in the general population were also associated with HTN in RA patients. Further research is needed to better understand risk factors for HTN throughout RA disease progression.

Available for download on Sunday, December 31, 2023