Early-stage hypertension defined by the 2017 ACC/AHA blood pressure guideline carries excessive cardiovascular risk in axial spondyloarthritis patients.

Background: Hypertension (HTN) is the most important modifiable risk factor for the development of cardiovascular events (CVEs). Patients with axSpA are also associated with an increased risk of future CVE.

Objectives: To ascertain whether baseline early-stage HTN is a predictor of future CVE in addition to inflammation in patients with axial spondyloarthritis (axSpA).

Design: A retrospective cohort study.

Methods: Patients with axSpA were recruited from 2001 to 2017. Patients with at least 2 years of follow-up and without prior CVE were divided into three groups according to the calculated mean blood pressure (BP) over the first 2-year follow-up period (adjusted mean BP) (⩾140/90, 130-139/80-89, and <130/80 mm Hg). They were followed from baseline until the end of 2020 or the occurrence of a first CVE. Multivariate Cox regression analyses adjusting for baseline and time-varying variables were used to assess the relationship between mean BP and CVE.

Results: Out of the 437 patients fulfilling the inclusion criteria, 49 (11.2%) and 132 (30.2%) had an adjusted mean BP ⩾ 140/90 and 130-139/80-89 mm Hg, respectively, and 256 (58.6%) were pre-HTN. After a median follow-up of 12 (7-18) years, 56 (12.8%) CVEs were documented. The incidence rates were 21.4, 14.2, and 5.9 per 1000 patient-years for the three groups, respectively. Baseline adjusted mean BP of 130-139/80-89 mm Hg was independently associated with the occurrence of CVE after adjusting for the baseline covariates as well as time-varying high inflammatory burden.

Conclusion: Baseline-defined early-stage HTN carries excessive risk of developing CVE which may be due to untreated inflammatory burden. Early antihypertensive therapy should target this BP level to minimize their future risk of CVE.