Cardiac Rehabilitation Lowers Risk in Rheumatoid Arthritis with Hypertension

Key Takeaways

• Framingham Risk Score was lower with rehabilitation than with usual care by week 24.
• Ambulatory systolic blood pressure and VO₂max changed in directions that favored rehabilitation during follow-up.
• Disease activity remained within the remission range, and QRISK3 showed a similar but non-significant pattern at week 24.

In a single-center randomized controlled trial, patients with rheumatoid arthritis and hypertension assigned to a 6-week supervised cardiac rehabilitation program had a week 24 Framingham Risk Score difference of -5.02 points versus usual care.

Researchers randomized 50 patients with rheumatoid arthritis and hypertension 1:1 to a 6-week supervised cardiac rehabilitation program or usual care. The intervention combined supervised aerobic, resistance, and flexibility training with weekly educational sessions. Blinded evaluators assessed outcomes at baseline and at 6, 12, and 24 weeks. Analyses used linear mixed-effects models under the intention-to-treat principle, and participants were clinically stable and receiving stable pharmacologic therapy. The primary analysis centered on cardiovascular risk estimation, with blood pressure, fitness, and disease activity evaluated as secondary measures.

The primary outcome was estimated 10-year cardiovascular risk using the Framingham Risk Score, while QRISK3 served as a supportive risk measure. A significant group × time interaction was reported for Framingham Risk Score, with p < 0.001. At week 24, the between-group difference was -5.02 points, with a 95% CI of -8.60 to -1.44 and p = 0.007. QRISK3 moved in the same direction at week 24, but the estimate of -5.77 points was not statistically significant, with a 95% CI of -12.54 to 1.01 and p = 0.094. Overall, the risk-score pattern favored rehabilitation across follow-up.

Among secondary outcomes, 24-hour ambulatory systolic blood pressure and VO₂max each showed significant group × time interactions, with p < 0.001 for both measures. By week 24, the between-group difference was -9.70 mmHg for ambulatory systolic blood pressure. VO₂max differed by +4.90 mL·kg⁻¹·min⁻¹ at the same time point. DAS28-CRP disease activity remained within the remission range throughout follow-up. The cardiovascular and fitness changes were not accompanied by worsening rheumatoid arthritis activity.

The investigators concluded that the structured program was associated with improved estimated cardiovascular risk profiles, lower ambulatory systolic blood pressure, and higher cardiorespiratory fitness in this selected trial population. Rheumatoid arthritis disease activity remained controlled during follow-up. These findings support further evaluation of cardiac rehabilitation as an adjunctive strategy for cardiovascular risk management in selected patients with rheumatoid arthritis and coexisting hypertension.