Kutluca A; Kayseri City Training and Research Hospital, Kayseri, Turkiye.
Sutbeyaz ST; Calis HT; Demirelli S; Citil E

International Journal of Rheumatic Diseases. 29(7):e70793, 2026 Jul.

OBJECTIVE: Patients with rheumatoid arthritis (RA) have an increased risk
of cardiovascular disease, particularly when hypertension coexists.
However, evidence regarding the role of cardiac rehabilitation (CR) in
this high-risk population remains limited. In this randomized controlled
trial, the effects of a structured CR program on estimated cardiovascular
risk, ambulatory blood pressure, and cardiorespiratory fitness were
evaluated in patients with RA and hypertension.

METHODS: In this single-center randomized controlled trial, 50 patients
with RA and hypertension were randomly assigned (1:1) to a 6-week
supervised CR program or usual care. The intervention included supervised
aerobic, resistance, and flexibility training together with weekly
educational sessions. Outcomes were assessed at baseline and at 6, 12, and
24 weeks by blinded evaluators. The primary outcome was estimated 10-year
cardiovascular risk assessed using the Framingham Risk Score (FRS), with
QRISK3 analyzed as a supportive risk measure. Secondary outcomes included
24-h ambulatory systolic blood pressure measured by ambulatory blood
pressure monitoring (ABPM), cardiorespiratory fitness assessed by
treadmill cardiopulmonary exercise testing (VO2max), and rheumatoid
arthritis disease activity (DAS28-CRP). Longitudinal changes were analyzed
using linear mixed-effects models according to the intention-to-treat
principle.

RESULTS: Linear mixed-effects modeling demonstrated a significant group x
time interaction for FRS (p < 0.001). At Week 24, the between-group
difference in FRS was -5.02 points (95% CI -8.60 to -1.44; p = 0.007).
QRISK3 showed a similar directional reduction but did not reach
statistical significance at Week 24 (-5.77 points; 95% CI -12.54 to 1.01;
p = 0.094). Significant group x time interactions were also observed for
24-h ambulatory systolic blood pressure (p < 0.001) and VO2max (p <
0.001). At Week 24, the between-group difference was -9.70 mmHg for
ambulatory systolic blood pressure and + 4.90 mL.kg-1.min-1 for VO2max.
Disease activity remained within the remission range throughout follow-up.

CONCLUSION: In selected patients with clinically stable rheumatoid
arthritis and coexisting hypertension who were receiving stable
pharmacologic therapy and were able to participate in supervised exercise,
a structured cardiac rehabilitation program was associated with
improvements in estimated cardiovascular risk profiles, ambulatory
systolic blood pressure, and cardiorespiratory fitness without worsening
disease activity. These findings support further evaluation of cardiac
rehabilitation as an adjunctive strategy for cardiovascular risk
management in a selected cardiometabolically high-risk rheumatoid
arthritis population with hypertension.