For a study, researchers examined the effects of disease-modifying medications for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years, in a large administrative database. Among patients with RA, researchers utilized administrative Veterans Affairs databases to identify unique methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone dispensing occurrences. Changes in SBP and DBP in the six months leading up to the start of a disease-modifying antirheumatic medication were compared to changes in the six months following starting. The likelihood of developing incident hypertension within three years (new hypertension diagnostic code and antihypertensive prescription) was also examined. The influence of confounding by indication was examined using multivariable models and propensity analyses.

Data was collected from 37,900 therapy regimens involving 21,216 distinct patients. In the six months leading up to the start of a disease-modifying antirheumatic medication, there were no changes in SBP or DBP (all P0.62). SBP (β=1.08 [1.32 to 0.85]; P<0.0001) and DBP (β=0.48 [0.62 to 0.33]; P<0.0001), on the other hand, decreased throughout the six months following commencement. Methotrexate and hydroxychloroquine users saw the largest reduction. After six months of therapy, methotrexate users were 9% more likely to achieve optimum blood pressure (BP). Patients using leflunomide had higher BP and a higher likelihood of developing hypertension than those on methotrexate (hazard ratio, 1.53 [1.21–1.91]; P<0.001).

Treatment for RA, especially methotrexate or hydroxychloroquine, may improve blood pressure. In contrast, leflunomide usage was linked to higher blood pressure and a higher risk of hypertension.