PP.27.25: LEFLUNOMIDE INDUCED HYPERTENSION. (June 2015)

• Record Type: Journal Article
• Authors: Karras, G.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000468536.67168.e9
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Leflunomide is an immunosuppressive drug with an anti-inflammatory action. It inhibits the biosynthesis of pyramidine in rapidly dividing cells and is used as a disease – modifying antirheumatic drug (DMARD) in patients with rheumatoid and psoriatic athritis. Leflunomide-related hypertension has been noted in up to 10% of patients. It can aggravate pre-existing hypertension or induce new-onset hypertension within three months of therapy. Design and method: A 47 year old female with rheumatoid arthritis was in treatment with leflunomide (20 mg/day) – onset of treatment 3 months. Previous history: cholecystetomy, rheumatoid athritis (good response in current therapy). The blood pressure of the patient increased during treatment with leflunomide (home blood pessure measurements). The physical examination revealed: blood pressure 155/90 mmHg, HR 80 pulse/min, rhymth, BMI 23.4, neck palpation and auscultation of both carotid arteries was normal. Pulmonary and cardiac auscultation was normal. Abdomen: without masses and bruits, limbs: without oedema, pulse palpation was normal. Laboratory analysis revealed Ht 43%, Hg14 g/dl PLT (Platelet count) 246000, WBC 6.000 cells/mcL, ESR30 mm/h CRP 1.1 mg/dl, LDH 199 UI/I glucoze 75 mg/dl, cholesterol 200 mg/dl, HDL Cholesterol 50 mg/dl, triglicerides 120 mg/dl, LDL Cholesterol 74 mg/dl, creatinine 0.70 mg/dl, BUN 40 mg/dl, uric acid 5.2, albumin 4.20 mg/dl mg/dl, K 3.8 mmol/l, Na 140 mmol/l, calcium 10 mg/dl, creatinine clerance = 95 ml/min, urinalysis was normal. Fundoscopy: retinopathy grade 1(mild retinopathy). EKG and echocardiography were normal. Renal ultrasonography: normal. Further investigation for secondary hypertension was negative. Results: The patient received reduced dose of lefunomide and antihypertensive treatment with good control of blood pressure. Conclusions: Most experts consider hypertension to be manageable during treatment with either a maintained or reduced dose of leflunomide and by giving antihypertensive treatment. Patients should be warned about the potential for mild adverse effects with leflunomide. The necesity for regular blood monitoring should be emphasised.