Factors That Impact Decision Making Among Rheumatologists in the Initiation of Treatment for Hypertension in Rheumatoid Arthritis

Background: Increased risks of morbidity and mortality from cardiovascular (CV) events are reported in patients with rheumatoid arthritis (RA). Recent reviews recommend aggressive treatment of modifiable CV risk factors, including systemic hypertension (HTN).

Objectives: We examined possible contributory factors influencing HTN treatment among RA patients by rheumatologists.

Methods: We conducted a cross-sectional 36-item survey of randomly chosen rheumatologists from the American College of Rheumatology directory collecting the rheumatologists' demographics, practice, and perceptions regarding HTN treatment in their RA patients. Our response variable was initiation of HTN treatment. Independent variables were derived from responses to the survey, and data were analyzed using bivariate analysis and logistic regression.

Results: Of 938 rheumatologists surveyed, 285 (30%) responded, 236 were subsequently analyzed. Respondents' mean age was 52.8 years; 75% were male and most were white (83%). Respondents reported routinely screening for HTN (92.8%), and initiating treatment for HTN (31%) in RA patients. Rheumatologists who believed that their RA patients did not have adequate visits with their primary care providers (PCP) were 2.2 times as likely to initiate treatment for HTN (41.1% vs. 24.3%; P = 0.006). Conversely, 33% of rheumatologists who did not routinely initiate treatment for HTN in their RA patients also did not believe patient access to PCP care was adequate. No associations were observed between initiation of HTN treatment and physician demographic or practice items.

Conclusion: The need for more effective minimization of CV risks in RA patients should prompt rheumatologists to consider a revision of routine practice standards to include treatment of uncontrolled HTN or promotion of improved communication with their PCPs.