Cardio-Rheumatology Insights Into Hypertension: Intersection of Inflammation, Arteries, and Heart

Abstract

There is an increased prevalence of atherosclerotic cardiovascular disease (ASCVD) in patients with inflammatory rheumatic diseases (IRD) including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis. The mechanism for the development of ASCVD in these conditions has been linked not only to a higher prevalence and undertreatment of traditional cardiovascular (CV) risk factors but importantly to chronic inflammation and a dysregulated immune system which contribute to impaired endothelial and microvascular function, factors that may contribute to accelerated atherosclerosis. Accurate ASCVD risk stratification and optimal risk management remain challenging in this population with many barriers that include lack of validated risk calculators, the remitting and relapsing nature of underlying disease, deleterious effect of medications used to manage rheumatic diseases, multimorbidity, decreased mobility due to joint pain, and lack of clarity about who bears the responsibility of performing CV risk assessment and management (rheumatologist vs. primary care provider vs. cardiologist). Despite recent advances in this field, there remain significant gaps in knowledge regarding the best diagnostic and management approach. The evolving field of Cardio-Rheumatology focuses on optimization of cardiovascular care and research in this patient population through collaboration and coordination of care between rheumatologists, cardiologists, radiologists, and primary care providers. This review aims to provide an overview of current state of knowledge about ASCVD risk stratification in patients with IRD, contributing factors including effect of medications, and review of the current recommendations for cardiovascular risk management in patients with inflammatory disease with a focus on hypertension as a key risk factor.

Keywords: atherosclerotic cardiovascular risk; cardio-rheumatology; hypertension; inflammation; inflammatory rheumatic diseases.

Figure 1.

Range of cardiovascular problems in inflammatory rheumatic diseases. ASCVD, atherosclerotic cardiovascular disease; ACS, acute coronary syndromes; CHF, congestive heart failure; HfrEF, heart failure with reduced ejection fraction; HfpEF, heart failure with preserved ejection fraction.

Figure 2.

Risk factors for atherosclerotic cardiovascular disease in patients with inflammatory rheumatic diseases.

Figure 3.

Factors contributing to the development of hypertension in inflammatory rheumatic diseases; RAAS, renin–angiotensin–aldosterone system.