Skip to main content Skip to main navigation menu Skip to site footer

Association incidence of hypertension in different types of rheumatic disease: an analysis of the effect of age and body mass index


Introduction: Increased prevalence of hypertension compared to the general population has been repeatedly reported in patients with rheumatic diseases, including rheumatoid arthritis (RA), psoriatic arthritis (PSA), systemic lupus erythematosus (SLE), gout arthritis, and osteoarthritis. This is believed to be associated with systemic inflammation and the effects of specific disease treatments. This study delves into the intricate relationship between hypertension and various rheumatic diseases, encompassing RA, PSA, SLE, gout arthritis, and osteoarthritis. Given the pivotal role of hypertension as a modifiable risk factor for cardiovascular diseases, our investigation aimed to scrutinize its prevalence within the rheumatic disease spectrum while dissecting the nuanced impact of age and body mass index (BMI) on its incidence.

Methods: This was an observational analytical study with a cross-sectional design. We meticulously analyzed all patient visits to the Rheumatology Clinic between January 2022 and August 2023. The diagnosis criteria for hypertension are based on the 2020 International Society of Hypertension Global Hypertension Practice Guidelines. The Kolmogorov-Smirnov test assesses data normality, and Mann-Whitney and Chi-Square tests are applied for non-normally distributed data. Statistical significance is considered when the p-value is <0.05.

Results: Our findings revealed a substantial occurrence of hypertension among rheumatic disease subjects, reaching 35.2%, coupled with a disconcertingly low treatment compliance rate of 32.6%. Osteoarthritis exhibited the highest prevalence at 47%, followed by gouty arthritis (38.2%), RA (35%), and SLE (34.7%). Significantly, Chi-Square analysis illuminated a noteworthy association between age groups and hypertension incidence in osteoarthritis and SLE cases.

Conclusion: Hypertension manifests more prominently in the rheumatic disease population than in the general healthy populace. Osteoarthritis and SLE, in conjunction with age-related factors, collectively exert a substantial influence on the incidence of hypertension, unraveling a multifaceted interplay between these variables within the rheumatic landscape.


  1. Lukito AA, Harmeiwaty E, Hustrini NM. Konsensus Penatalaksanaan Hipertensi. Jakarta: Perhimpunan Dokter Hipertensi Indonesia; 2019. 1–118 p.
  2. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334–57.
  3. Mokti K, Rahime SSSA. Relationship of age, body mass index (BMI), physical activity, salt intake, and stress with high blood pressure among rural dwellers in Kudat, Sabah. Bali Medical Journal. 2022;11(1):360–7.
  4. Pakpahan M, Eka NGA, Florensa MVA. Stress associated with hypertension in middle-age and elderly in Binong, Tangerang. Bali Medical Journal. 2022;11(2):547–50.
  5. Anyfanti P, Gkaliagkousi E, Triantafyllou A, Koletsos N, Gavriilaki E, Galanopoulou V, et al. Hypertension in rheumatic diseases: prevalence, awareness, treatment, and control rates according to current hypertension guidelines. J Hum Hypertens. 2021;35(5):419–27.
  6. Baghdadi LR, Woodman RJ, Shanahan EM, Mangoni AA. The Impact of Traditional Cardiovascular Risk Factors on Cardiovascular Outcomes in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(2):e0117952.
  7. SABIO JM, VARGAS-HITOS JA, NAVARRETE-NAVARRETE N, MEDIAVILLA JD, JIMÉNEZ-JÁIMEZ J, DÍAZ-CHAMORRO A, et al. Prevalence of and Factors Associated with Hypertension in Young and Old Women with Systemic Lupus Erythematosus. J Rheumatol. 2011;38(6):1026–32.
  8. Shanmugam VK, Steen VD. Renal Manifestations in Scleroderma: Evidence for Subclinical Renal Disease as a Marker of Vasculopathy. Int J Rheumatol. 2010;2010:1–8.
  9. Sulaiman W, Tan LK, Mat H, Tohar N, Muhaimin Fathi A, Kosenin NMA, et al. Clinical characteristics and comorbidities in psoriatic arthritis: Experience from a single rheumatology centre in Malaysia. The Egyptian Rheumatologist. 2023;45(4):309–13.
  10. Jamnitski A, Symmons D, Peters MJL, Sattar N, MciInnes I, Nurmohamed MT. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis. 2013;72(2):211–6.
  11. Wielosz E, Dryglewska M, Górak A, Łyś E, Majdan M. Arterial hypertension in systemic sclerosis. Advances in Dermatology and Allergology. 2022;39(5):865–71.
  12. Lo K, Au M, Ni J, Wen C. Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies. J Orthop Translat. 2022;32:12–20.
  13. McAdams‐DeMarco MA, Maynard JW, Baer AN, Coresh J. Hypertension and the Risk of Incident Gout in a Population‐Based Study: The Atherosclerosis Risk in Communities Cohort. The Journal of Clinical Hypertension. 2012;14(10):675–9.
  14. Warsinggih, Ulfandi D, Fajar A, Faruk M. Factors associated with TNF-alpha levels in patients with indirect inguinal hernia: A cross-sectional study. Annals of Medicine & Surgery. 2022;78.
  15. Fajar A, Warsinggih, Syarifuddin E, Hendarto J, Labeda I, Lusikooy RE, et al. The relationship between glycine levels in collagen in the anterior rectus sheath tissue and the onset of indirect inguinal hernia: A cross-sectional study. Annals of Medicine & Surgery. 2022;73.
  16. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400–12.
  17. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology. 2012;51(suppl 6):vi5–9.
  18. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–49.
  19. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum. 1990;33(11):1601–10.
  20. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505–14.
  21. Neogi T, Jansen TLThA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis & Rheumatology. 2015;67(10):2557–68.
  22. Ayub N, Faraj M, Ghatan S, Reijers JAA, Napoli N, Oei L. The Treatment Gap in Osteoporosis. J Clin Med. 2021;10(13):3002.
  23. Leung YY, Ogdie A, Orbai A-M, Tillett W, Coates LC, Strand V, et al. Classification and Outcome Measures for Psoriatic Arthritis. Front Med (Lausanne). 2018;5.
  24. Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extraarticular manifestations and comorbidities. Autoimmun Rev. 2021;20(4):102776.
  25. Kementerian Kesehatan RI. Laporan Riskesdas 2018. Laporan Nasional Riskesdas 2018. 2018;53(9):154–65. Available from: No. 57 Tahun 2013 tentang PTRM.pdf
  26. Jaam M, Hadi MA, Kheir N, Mohamed Ibrahim MI, Diab M, Al-Abdulla S, et al. A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers. Patient Prefer Adherence. 2018;Volume 12:2205–16.
  27. Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(1).
  28. Wilkie R, Blagojevic‐Bucknall M, Jordan KP, Lacey R, McBeth J. Reasons Why Multimorbidity Increases the Risk of Participation Restriction in Older Adults With Lower Extremity Osteoarthritis: A Prospective Cohort Study in Primary Care. Arthritis Care Res (Hoboken). 2013;65(6):910–9.
  29. Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, et al. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. Int J Environ Res Public Health. 2022;19(19):12036.
  30. Chowdhury T, Dutta J, Noel P, Islam R, Gonzalez-Peltier G, Azad S, et al. An Overview on Causes of Nonadherence in the Treatment of Rheumatoid Arthritis: Its Effect on Mortality and Ways to Improve Adherence. Cureus. 2022;
  31. Shaharir SS, Mustafar R, Mohd R, Mohd Said MS, A. Gafor H. Persistent hypertension in lupus nephritis and the associated risk factors. Clin Rheumatol. 2015;34(1):93–7.
  32. Garcia-Gonzalez A, Gonzalez-Lopez L, Valera-Gonzalez IC, Cardona-Muñoz EG, Salazar-Paramo M, González-Ortiz M, et al. Serum leptin levels in women with systemic lupus erythematosus. Rheumatol Int. 2002;22(4):138–41.
  33. Panoulas VF, Metsios GS, Pace A V., John H, Treharne GJ, Banks MJ, et al. Hypertension in rheumatoid arthritis. Rheumatology. 2008;47(9):1286–98.
  34. Luque Ramos A, Redeker I, Hoffmann F, Callhoff J, Zink A, Albrecht K. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol. 2019;46(6):564–71.
  35. Solak Y, Afsar B, Vaziri ND, Aslan G, Yalcin CE, Covic A, et al. Hypertension as an autoimmune and inflammatory disease. Hypertension Research. 2016;39(8):567–73.
  36. Mattace-Raso FU, Verwoert GC, Hofman A, Witteman JC. Inflammation and incident-isolated systolic hypertension in older adults: the Rotterdam study. J Hypertens. 2010;28(5):892–5.
  37. Munguia-Realpozo P, Mendoza-Pinto C, Sierra Benito C, Escarcega RO, Garcia-Carrasco M, Mendez Martinez S, et al. Systemic lupus erythematosus and hypertension. Autoimmun Rev. 2019;18(10):102371.
  38. Taylor EB, Ryan MJ. Understanding mechanisms of hypertension in systemic lupus erythematosus. Ther Adv Cardiovasc Dis. 2017;11(1):20–32.
  39. Choi HK, Soriano LC, Zhang Y, Rodriguez LAG. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ. 2012;344(jan12 1):d8190–d8190.
  40. Veronese N, Stubbs B, Solmi M, Smith TO, Noale M, Schofield P, et al. Knee Osteoarthritis and Risk of Hypertension: A Longitudinal Cohort Study. Rejuvenation Res. 2018;21(1):15–21.
  41. Kremers HM, Crowson CS, Therneau TM, Roger VL, Gabriel SE. High ten‐year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: A population‐based cohort study. Arthritis Rheum. 2008;58(8):2268–74.
  42. Jagpal A, Navarro-Millán I. Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment. BMC Rheumatol. 2018;2(1):10.
  43. RIZK A, GHEITA TA, NASSEF S, ABDALLAH A. The impact of obesity in systemic lupus erythematosus on disease parameters, quality of life, functional capacity and the risk of atherosclerosis. Int J Rheum Dis. 2012;15(3):261–7.
  44. Niu J, Clancy M, Aliabadi P, Vasan R, Felson DT. Metabolic Syndrome, Its Components, and Knee Osteoarthritis: The Framingham Osteoarthritis Study. Arthritis & Rheumatology. 2017;69(6):1194–203.
  45. Hart DJ, Doyle D V, Spector TD. Association between metabolic factors and knee osteoarthritis in women: the Chingford Study. J Rheumatol. 1995;22(6):1118–23.
  46. YOSHIMURA N, MURAKI S, OKA H, KAWAGUCHI H, NAKAMURA K, AKUNE T. Association of Knee Osteoarthritis with the Accumulation of Metabolic Risk Factors Such as Overweight, Hypertension, Dyslipidemia, and Impaired Glucose Tolerance in Japanese Men and Women: The ROAD Study. J Rheumatol. 2011;38(5):921–30.
  47. Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, et al. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis Cartilage. 2012;20(11):1217–26.
  48. Veronese N, Cereda E, Maggi S, Luchini C, Solmi M, Smith T, et al. Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis. Semin Arthritis Rheum. 2016;46(2):160–7.

How to Cite

Setiawan, D. R., Adnan, E., Ramadhan, S. R. Z., Bakri, S., Tandean, P., & Zainuddin, A. A. (2024). Association incidence of hypertension in different types of rheumatic disease: an analysis of the effect of age and body mass index. Bali Medical Journal, 13(2), 755–760.




Search Panel

Dicky Rahmat Setiawan
Google Scholar
BMJ Journal

Endy Adnan
Google Scholar
BMJ Journal

Sitti Rabiul Zatalia Ramadhan
Google Scholar
BMJ Journal

Syakib Bakri
Google Scholar
BMJ Journal

Pendrik Tandean
Google Scholar
BMJ Journal

Andi Alfian Zainuddin
Google Scholar
BMJ Journal