Γενετική ρύθμιση της υπέρτασης σε ασθενείς με ρευματοειδή αρθρίτιδα (Doctoral thesis)

Πανούλας, Βασίλειος Φ.


Cardiovascular disease (CVD) is the main contributor to the increased morbidity and mortality of rheumatoid arthritis (RA). Intensive research efforts focus on identifying the factors that may lead to excessive CVD burden in RA. Hypertension is one of the most important modifiable CVD risk factors in the general population and in patients with RA, where it has been shown to associate with subclinical atherosclerosis and to be an independent predictor of CVD. Despite this, until recently, the prevalence, clinical associations, causes and management of hypertension in RA had not been investigated in any depth. We showed that hypertension affects 70% of British RA patients in secondary care, and through a subsequent systematic review demonstrated that this high prevalence is not just a UK phenomenon. We also showed that a significant proportion (40%) of hypertensive RA patients remain undiagnosed, and thus untreated, while in the majority (80%) of those who are on treatment, blood pressure (BP) remains poorly controlled. This highlighted the need for effective screening and management strategies, specific to this population. For this reason, we performed further work, aiming to identify risk factors for hypertension specifically in RA. Advancing age, obesity, and long term corticosteroid use were the strongest, clinically identifiable, independent predictors of hypertension in the total RA population. Young age (<45 years) was associated with undiagnosed hypertension, while older age (>65 years), together with obesity and comorbid CVD associated with poor BP control, which was commoner in RA than that reported in the general population. These results are of importance in the clinical arena, as they can inform effective, targeted screening strategies for hypertension and its control in RA patients. Of particular interest was also that serum uric acid was strongly, independently associated with hypertension and with CVD in RA. This association is well?described in the general population and may be of pathogenic significance particularly at the early stages of hypertension, but was surprising in RA, in view of the mutual exclusivity of RA and gout. Future studies on the role of uric acid?lowering therapy in hypertension control may be of interest in RA. There are several factors potentially involved in the pathophysiology of hypertension in RA, including: i) systemic inflammation per se; ii) lifestyle factors, such as sedentarity, leading to obesity which, in turn, is highly prevalent and associates independently with hypertension in RA; iii) medications with hypertensive potential, some of which are commonly used in RA, such as non steroidal anti?inflammatory drugs and cyclooxygenase 2 specific inhibitors, some disease?modifying anti?rheumatic drugs (particularly leflunomide and cyclosporin, and glucocorticosteroids); iv) genetic predisposition, which is thought to account for 30 to 50% of essential hypertension.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων Σχολή Ιατρικής Τμήμα Ιατρικής Τομέας Παθολογικός Κλινική Β' Παθολογική Πανεπιστημιακού Γενικού Νοσοκομείου Ιωαννίνων
Subject classification: Ρευματοειδής αρθρίτιδα
Keywords: Ρευματοειδής αρθρίτιδα,Υπέρταση,Γονίδια,Πολυμορφισμοί,Ουρικό οξύ,Φλεγμονές,Καρδιαγγειακή νόσος,Γλυκοκορτικοστεροειδή
URI: http://olympias.lib.uoi.gr/jspui/handle/123456789/784
Link: http://thesis.ekt.gr/thesisBookReader/id/18146#page/1/mode/2up
Appears in Collections:Διδακτορικές Διατριβές

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