Objective Despite numerous studies reporting increased cardiovascular disease (CVD) in patients

Objective Despite numerous studies reporting increased cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) the MDL 29951 impact of RA on managing modifiable CVD risk factors remains understudied. elevated blood pressure or antihypertensive medication prescription. Kaplan Meier (KM) Survival and Cox proportional hazard modeling were used to MDL 29951 examine the impact of RA on diagnosis of hypertension. Results Among 14 974 patients with undiagnosed hypertension 201 patients had RA codes. RA patients had equivalent main care visits and more total visits compared to patients without RA. At study end the likelihood of hypertension diagnosis was 36% in RA patients compared to 51% without RA. In adjusted Cox models RA patients experienced 29% lower hypertension diagnosis hazard [Hazard Ratio 0.71 0.55 reflecting more undiagnosed hypertension than with other comorbidities. Conclusion Among patients meeting guideline-based hypertension criteria RA patients were less likely to be diagnosed despite more visits than those without RA. Given heightened CVD risks in RA and the importance of hypertension diagnosis as a first step MDL 29951 toward controlling risk rheumatologists should collaborate VRP to improve rates of diagnosis for this modifiable CVD risk factor. Introduction Patients with rheumatoid arthritis (RA) have 50-60% increased incidence of cardiovascular disease (CVD) events and premature death as compared to those without this disease due to both RA itself and traditional CVD risk factors (1 2 Mortality has declined in the general populace in recent decades with much of that reduction attributed to improved CVD preventative care (3). Nearly half of the survival gains in the US general populace in the last 20 years have been credited to lowering systolic blood pressures and cholesterol levels. However the mortality space between RA patients and the general populace has widened over the last decades (4) for unclear reasons. Based upon our prior work demonstrating low lipid screening in Medicare RA patients (5 6 we broadly hypothesized that MDL 29951 RA patients despite increased CVD risk have not received as much CVD preventive care as non-RA peers. Specifically in the present work we focus on hypertension a prevalent and modifiable risk factor for increased CVD in both RA patients and the general populace. Several studies cite hazards for the impact of hypertension on CVD events in RA patients ranging from 2.8 to 3.8 (7 8 Prior studies have reported wide variations in prevalence of hypertension among RA patients ranging from 3.8% to 73% (9). Such studies have rarely applied standard clinical guidelines like the Seventh Statement of the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure (JNC-7) criteria and have rarely simultaneously examined non-RA comparisons (10-17). Given that the clinical standard for any hypertension diagnosis in the US entails serial measurements and interpretation per JNC-7 guidelines an integrated main care and multispecialty health system is an optimal setting to examine the impact of RA upon hypertension diagnosis during routine clinical care. Therefore in a populace of patients with and without RA who received regular main care and met definitions for incident JNC-7 hypertension we tested the hypothesis that RA is a risk factor for missed hypertension diagnosis and examined the predictors of an initial diagnosis of hypertension. Patients MDL 29951 and Methods Sample Definition In a large academic multispecialty practice with a shared electronic health record (EHR) we defined a cohort of all adults ≥18 years old who were regularly seen in main care and met the definition of guideline-based hypertension using an EHR algorithm but lacked prior hypertension diagnosis or treatment. Using this EHR search-defined cohort we compared the likelihood of receiving a new diagnosis in patients with MDL 29951 and without RA (Physique 1); similarly we used automated EHR searches for RA status and diagnosis to minimize potential for ascertainment bias. Regular main care was defined as having 2 or more network main care ambulatory visits in 36 months with at least 1 of those visits in the most recent 24.