Which rheumatoid arthritis medication may lead to hypertension?

Leflunomide is known to potentially cause hypertension as a side effect. This medication is an immunosuppressant that works by inhibiting the proliferation of lymphocytes, which are involved in the inflammatory response seen in rheumatoid arthritis. While effective for treating the disease, leflunomide is also associated with various adverse effects, including effects on blood pressure. The mechanism behind this can involve fluid retention and effects on vascular smooth muscle, contributing to elevated blood pressure in some patients.

Other medications listed may have side effects, but they do not typically lead to hypertension. Methotrexate, for example, is a cornerstone in the treatment of rheumatoid arthritis and generally does not affect blood pressure significantly. Hydroxychloroquine is primarily used for its anti-inflammatory effects and has a favorable safety profile regarding blood pressure. Prednisolone, a corticosteroid, can cause fluid retention which may lead to transient hypertension, but it is mainly associated with other metabolic effects and not a primary cause of sustained hypertension compared to leflunomide. Thus, leflunomide is the medication most closely associated with inducing hypertension among the options provided.