Infliximab, a TNF-α Inhibitor, Reduces 24-h Ambulatory Blood Pressure in Rheumatoid Arthritis Patients

Overview

Journal J Hum Hypertens

Specialty Cardiology & Vascular Diseases

Date 2013 Sep 6

PMID 24005958

Citations 47

Authors

S Yoshida

T Takeuchi

T Kotani

N Yamamoto

K Hata

K Nagai

T Shoda

S Takai

S Makino

T Hanafusa

Affiliations

Soon will be listed here.

Abstract

Tumour necrosis factor-alpha (TNF-α) is an important mediator in the pathogenesis of rheumatoid arthritis (RA) and hypertension. TNF-α inhibitors improve clinical symptoms and inhibit joint destruction in RA, but their effect on blood pressure (BP) has not been fully investigated. We measured 24-h BP using an ambulatory BP monitor in 16 RA patients treated with a TNF-α inhibitor, infliximab, to investigate its influence on BP and its association with the regulatory factors of BP and renin-angiotensin-aldosterone and sympathetic nervous systems. Infliximab significantly reduced the 24-h systolic BP (SBP) from 127.4±21.8 to 120.1±23.4 mm Hg (P<0.0001). Particularly, morning BP (0600-0800 h) decreased from 129.7±19.7 to 116.9±13.4 mm Hg (P<0.0001), and daytime BP decreased from 131.8±15.1 to 122.5±13.7 mm Hg (P<0.0001). Infliximab significantly reduced the plasma level of norepinephrine and plasma renin activity (PRA) (from 347.5±180.7 to 283.0±181.8 pg ml(-1) and 2.6±2.7 to 2.1±2.9 ng ml(-1) h(-1), respectively) but did not significantly reduce the plasma levels of dopamine and epinephrine. The reduction in morning SBP correlated with the reduction in the norepinephrine level (P<0.05) but not with that in PRA and inflammatory parameters related to RA. This study shows the effect of infliximab on ambulatory BP, especially daytime BP, which may be partly accounted for by the reduction of sympathetic nerve activity after infliximab treatment.

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References

Furlan R, Guzzetti S, Crivellaro W, Dassi S, Tinelli M, Baselli G . Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation. 1990; 81(2):537-47. DOI: 10.1161/01.cir.81.2.537. View

Pickering T, Levenstein M, Walmsley P . Nighttime dosing of doxazosin has peak effect on morning ambulatory blood pressure. Results of the HALT Study. Hypertension and Lipid Trial Study Group. Am J Hypertens. 1994; 7(9 Pt 1):844-7. DOI: 10.1093/ajh/7.9.844. View

Goodson N, Wiles N, Lunt M, Barrett E, Silman A, Symmons D . Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum. 2002; 46(8):2010-9. DOI: 10.1002/art.10419. View

Popa C, van Tits L, Barrera P, Lemmers H, Van den Hoogen F, Van Riel P . Anti-inflammatory therapy with tumour necrosis factor alpha inhibitors improves high-density lipoprotein cholesterol antioxidative capacity in rheumatoid arthritis patients. Ann Rheum Dis. 2008; 68(6):868-72. DOI: 10.1136/ard.2008.092171. View

Dorffel Y, Latsch C, Stuhlmuller B, Schreiber S, SCHOLZE S, Burmester G . Preactivated peripheral blood monocytes in patients with essential hypertension. Hypertension. 1999; 34(1):113-7. DOI: 10.1161/01.hyp.34.1.113. View

Dodt C, Breckling U, Derad I, Fehm H, Born J . Plasma epinephrine and norepinephrine concentrations of healthy humans associated with nighttime sleep and morning arousal. Hypertension. 1997; 30(1 Pt 1):71-6. DOI: 10.1161/01.hyp.30.1.71. View

Prevoo M, van t Hof M, Kuper H, van Leeuwen M, van de Putte L, van Riel P . Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995; 38(1):44-8. DOI: 10.1002/art.1780380107. View

Panoulas V, Douglas K, Milionis H, Stavropoulos-Kalinglou A, Nightingale P, Kita M . Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford). 2007; 46(9):1477-82. DOI: 10.1093/rheumatology/kem169. View

Panza J, Epstein S, Quyyumi A . Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. N Engl J Med. 1991; 325(14):986-90. DOI: 10.1056/NEJM199110033251402. View

10.

Klarenbeek N, van der Kooij S, Huizinga T, Goekoop-Ruiterman Y, Hulsmans H, van Krugten M . Blood pressure changes in patients with recent-onset rheumatoid arthritis treated with four different treatment strategies: a post hoc analysis from the BeSt trial. Ann Rheum Dis. 2010; 69(7):1342-5. DOI: 10.1136/ard.2009.124180. View

11.

Takahashi H, Nishimura M, Sakamoto M, Ikegaki I, Nakanishi T, Yoshimura M . Effects of interleukin-1 beta on blood pressure, sympathetic nerve activity, and pituitary endocrine functions in anesthetized rats. Am J Hypertens. 1992; 5(4 Pt 1):224-9. DOI: 10.1093/ajh/5.4.224. View

12.

Van Doornum S, McColl G, Wicks I . Tumour necrosis factor antagonists improve disease activity but not arterial stiffness in rheumatoid arthritis. Rheumatology (Oxford). 2005; 44(11):1428-32. DOI: 10.1093/rheumatology/kei033. View

13.

Herrera J, Ferrebuz A, MacGregor E, Rodriguez-Iturbe B . Mycophenolate mofetil treatment improves hypertension in patients with psoriasis and rheumatoid arthritis. J Am Soc Nephrol. 2006; 17(12 Suppl 3):S218-25. DOI: 10.1681/ASN.2006080918. View

14.

Solomon D, Karlson E, Rimm E, Cannuscio C, Mandl L, Manson J . Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003; 107(9):1303-7. DOI: 10.1161/01.cir.0000054612.26458.b2. View

15.

Maki-Petaja K, Elkhawad M, Cheriyan J, Joshi F, Ostor A, Hall F . Anti-tumor necrosis factor-α therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis. Circulation. 2012; 126(21):2473-80. DOI: 10.1161/CIRCULATIONAHA.112.120410. View

16.

Portaluppi F, Bagni B, Degli Uberti E, Montanari L, CAVALLINI R, Trasforini G . Circadian rhythms of atrial natriuretic peptide, renin, aldosterone, cortisol, blood pressure and heart rate in normal and hypertensive subjects. J Hypertens. 1990; 8(1):85-95. DOI: 10.1097/00004872-199001000-00013. View

17.

Schlaich M, Lambert E, Kaye D, Krozowski Z, Campbell D, Lambert G . Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and Angiotensin neuromodulation. Hypertension. 2003; 43(2):169-75. DOI: 10.1161/01.HYP.0000103160.35395.9E. View

18.

Marfella R, Siniscalchi M, Portoghese M, Di Filippo C, Ferraraccio F, Schiattarella C . Morning blood pressure surge as a destabilizing factor of atherosclerotic plaque: role of ubiquitin-proteasome activity. Hypertension. 2007; 49(4):784-91. DOI: 10.1161/01.HYP.0000259739.64834.d4. View

19.

Elmarakby A, Quigley J, Pollock D, Imig J . Tumor necrosis factor alpha blockade increases renal Cyp2c23 expression and slows the progression of renal damage in salt-sensitive hypertension. Hypertension. 2006; 47(3):557-62. DOI: 10.1161/01.HYP.0000198545.01860.90. View

20.

Maeda K, Yasunari K, Watanabe T, Nakamura M . Oxidative stress by peripheral blood mononuclear cells is increased in hypertensives with an extreme-dipper pattern and/or morning surge in blood pressure. Hypertens Res. 2006; 28(9):755-61. DOI: 10.1291/hypres.28.755. View