Cardiac rehabilitation linked to lower cardiovascular risk in patients with rheumatoid arthritis and hypertension
A randomized trial of 50 patients with rheumatoid arthritis and hypertension found that a 6-week supervised cardiac rehabilitation program, including aerobic and resistance training plus education, was associated with a 5-point reduction in 10-year cardiovascular risk and a 9.7 mmHg lower ambulatory systolic blood pressure at 24 weeks compared to usual care.
Patients with rheumatoid arthritis face elevated cardiovascular disease risk, especially when hypertension is present, yet few studies examine whether standard cardiac rehabilitation works safely in this population. This single-center randomized controlled trial enrolled 50 patients with both RA and hypertension, randomly assigning them to either a 6-week supervised cardiac rehabilitation program or usual care, then tracking outcomes for 24 weeks.
The intervention combined supervised aerobic, resistance, and flexibility training with weekly educational sessions. The primary outcome was 10-year cardiovascular risk estimated using the Framingham Risk Score (FRS). At week 24, the rehabilitation group showed a 5.02-point lower FRS compared to usual care (95% CI −8.60 to −1.44; p=0.007)—a clinically meaningful reduction. The program also produced a 9.70 mmHg greater reduction in 24-hour ambulatory systolic blood pressure and a 4.90 mL·kg⁻¹·min⁻¹ larger gain in cardiorespiratory fitness (VO2max). Importantly, disease activity remained stable throughout follow-up in both groups, indicating the exercise program did not destabilize RA. The main limitation is the small single-center sample and exclusion of patients with active disease, which means results apply only to clinically stable RA patients able to tolerate supervised exercise.
The between-group reduction in 10-year cardiovascular risk of 5 points is clinically substantial—estimates suggest this translates to roughly a 15–20% relative reduction in absolute risk over a decade for this population. The 9.7 mmHg ambulatory systolic blood pressure reduction is particularly noteworthy because it was achieved in patients already on stable antihypertensive medication, suggesting the exercise stimulus provided additive benefit independent of pharmacotherapy. Cardiorespiratory fitness gains of 4.9 mL·kg⁻¹·min⁻¹ align with moderate aerobic training effects seen in healthier populations and are associated with improved survival. Secondary outcomes showed no worsening of RA disease activity (DAS28-CRP remained in remission range), and QRISK3, a secondary cardiovascular risk metric, trended downward (−5.77 points) but did not reach significance—possibly a power limitation. The study deliberately enrolled only patients with clinically stable RA on stable medications; those with active disease or recent flares were excluded, so generalization to more unstable patients remains unclear.
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- Cardiac Rehabilitation for Cardiovascular Risk Modification in Patients With Rheumatoid Arthritis and Hypertension: A Randomized Controlled Trial. — International journal of rheumatic diseases (Read the original)