TNFi use does not induce hypertension in ankylosing spondylitis

Use of tumour necrosis factor inhibitor (TNFi) does not appear to contribute to incident hypertension in individuals with ankylosing spondylitis (AS), reports a study.

A team of investigators examined adults with AS enrolled in a prospective cohort in 2002‒2018 every 4‒6 months and ascertained TNFi use during the preceding 6 months at each study visit. Hypertension was defined by patient-reported hypertension, antihypertensive medication use, or systolic blood pressure (SBP) ≥140 mm Hg or diastolic (D)BP ≥90 mm Hg on two consecutive visits.

The investigators then assessed the association between TNFi use and the development of hypertension with marginal structure models, estimated by inverse probability-of-treatment weighting, to account for time-dependent confounders and informative censoring. Potential confounders were age, sex, race, site, disease activity, and nonsteroidal anti-inflammatory drug use.

Overall, 630 patients (mean age 39 years) without baseline hypertension and with at least 1 year of follow-up participated in this study. Of these, majority were male (72 percent) and less than half (43 percent) used TNFi at baseline.

During a median follow-up of 5 years, 129 participants developed incident hypertension, and 163 initiated TNFi treatment. After adjusting for potential confounders, use of TNFi was found to have no significant association with incident hypertension (adjusted hazard ratio, 1.10, 95 percent confidence interval, 0.83‒1.37).

“Individuals with AS have a greater cardiovascular risk than those in the general population,” the investigators said. “The effect of TNFis on cardiovascular risk … remains unclear, with some data suggesting higher risk.”