Blood pressure is routinely measured when a patient visits a rheumatology clinic. But what happens when one of your patients has hypertension?
According to new research published in Arthritis Care & Research, slightly more than one-third of patients with rheumatoid arthritis (RA) who met guideline-based hypertension criteria received a diagnosis of hypertension compared with just over half of patients who met the same criteria but did not have RA.1
“That is a huge gap,” says lead author Christie Bartels, MD, MS, assistant professor of medicine-rheumatology at the University of Wisconsin School of Medicine and Public Health in Madison. “We measure blood pressure every visit, but it seems we are not doing a great job of following blood pressure trends and connecting primary care and specialty care.”
For the study, Bartels et al examined 14,974 undiagnosed hypertensive patients, 201 of whom had RA codes. Patients with RA and patients without RA had an equivalent number of visits with primary care physicians (PCPs), but patients with RA logged more total visits with doctors.
Despite more frequent physician visits, a hypertension diagnosis occurred in 36% of patients with RA, compared with 51% of patients without RA. Adjusted analysis showed patients with RA had a 29% lower hypertension diagnosis hazard (hazard ratio 0.71, 95% confidence interval 0.55–0.93) than other patients. Researchers also found that patients with RA were less likely to be diagnosed with hypertension than patients with other comorbidities, Dr. Bartels says.
“It’s important that patients, rheumatologists and PCPs all partner in this to help identify hypertension, to address it and reduce long-term risk,” Dr. Bartels says.
Dr. Bartels has been investigating gaps between primary and specialty care for nearly five years. Her previous research revealed low rates of lipid screening in patients with RA and hemoglobin A1c testing in older diabetic patients with RA compared with patients without RA.2,3
“All of these studies suggest that we may be overlooking modifiable CVD [cardiovascular disease] risk factors in patients with rheumatic diseases,” Dr. Bartels says. “One may argue that rheumatologists should collaborate to improve recognition and management of CVD risk factors. Improving care of high blood pressures would be a great start.” (posted 10/3/14)
Richard Quinn is a freelance writer in New Jersey.
References
1. Bartels CM, Johnson H, Voelker K, et al. Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care. Arthritis Care Res (Hoboken). 2014;66(9):1281–1288.
2. Bartels CM, Kind AJH, Everett C, et al. Low frequency of primary lipid screening among Medicare patients with rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1221–1230.
3. Bartels CM, Saucier JM, Thorpe CT, et al. Monitoring diabetes in patients with and without rheumatoid arthritis: A Medicare study. Arthritis Res Ther. 2012;14(4):R166.
