Objective: To determine the frequency of new-onset hypertension in patients with
Rheumatoid arthritis taking leflunomide, in comparison with methotrexate in Asian setting.
Material and Methods: Perspective case-control study was conducted in 2014 in a tertiary care
hospital located in Karachi, Pakistan. Adult patients, having rheumatoid arthritis were randomly
prescribed leflunomide or methotrexate. Patients having chronic hypertension, proteinuria and
chronic kidney disease were excluded. Patients were monthly followed for blood pressure and heart
rate measurements. Hypertension was defined using JNC 7 criteria.
Results: Out of 144 patients enrolled, 80 patients received Leflunomide while 64 were started on
methotrexate. Mean systolic blood pressure in leflunomide group at the start and at the end of study
was 108.5 and 135.4mmHg, respectively while in methotrexate group, mean systolic BP was 109.8
and 110.5 mmhg, respectively. After one year follow up, 33 out of 80 (41%) patients were receiving
leflunomide had pre-hypertension or hypertension, while only 3 out of 64 patients (4.7%) were
receiving methotrexate had hypertension.
Conclusion: Risk of developing hypertension in patient receiving Leflunomide is much higher in
Asian population like Pakistan as compared to western population.