The Association of Tumor Necrosis Factor Inhibitor Use With Incident Hypertension in Ankylosing Spondylitis: Data From the PSOAS Cohort

J Rheumatol. 2022 Mar;49(3):274-280. doi: 10.3899/jrheum.210332. Epub 2021 Dec 1.


Objective: Individuals with ankylosing spondylitis (AS) have a greater cardiovascular (CV) risk than those in the general population. The effect of tumor necrosis factor inhibitors (TNFis) on CV risk, including on the development of hypertension (HTN), remains unclear, with some data suggesting higher risk. We assessed the association of TNFi use with incident HTN in a longitudinal AS cohort.

Methods: Adults with AS enrolled in a prospective cohort in 2002-2018 were examined every 4-6 months. TNFi use during the preceding 6 months was ascertained at each study visit. We defined HTN by patient-reported HTN, antihypertensive medication use, or, on 2 consecutive visits, systolic blood pressure (BP) ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. We evaluated the association between TNFi use and the development of HTN with marginal structural models, estimated by inverse probability-of-treatment weighting, to account for time-dependent confounders and informative censoring. Potential confounders included age, sex, race, site, nonsteroidal antiinflammatory drug use, and disease activity.

Results: We included 630 patients without baseline HTN and with at least 1 year of follow-up. Of these, 72% were male, mean age was 39 ± 13 years, and 43% used TNFi at baseline. On follow-up (median 5 yrs), 129 developed incident HTN and 163 started on TNFi during follow-up. TNFi use was not associated with incident HTN (adjusted HR 1.10, 95% CI 0.83-1.37).

Conclusion: In our prospective AS cohort, TNFi use was not significantly associated with incident HTN.

Keywords: ankylosing spondylitis; cardiovascular diseases; spondyloarthropathy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antirheumatic Agents* / adverse effects
  • Cohort Studies
  • Female
  • Humans
  • Hypertension* / complications
  • Hypertension* / drug therapy
  • Hypertension* / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Spondylitis, Ankylosing* / complications
  • Spondylitis, Ankylosing* / drug therapy
  • Spondylitis, Ankylosing* / epidemiology
  • Treatment Outcome
  • Tumor Necrosis Factor Inhibitors
  • Tumor Necrosis Factor-alpha


  • Antirheumatic Agents
  • Tumor Necrosis Factor Inhibitors
  • Tumor Necrosis Factor-alpha