- Mean prior systolic blood pressure and diastolic blood pressure;
- Standard deviation of prior systolic and diastolic blood pressure; and
- Coefficient of variation of prior systolic and diastolic blood pressure.
The Findings
The researchers found the mean systolic blood pressure in SLE was significantly higher in younger patients (18–39 years old) than in the general population, and it increased with age. BPV in SLE was elevated across all ages and was significantly higher in African Americans, in those with high disease activity, in those taking prednisone and in patients with traditional cardiovascular risk factors. Hydroxychloroquine was associated with significantly lower BPV.
In a multivariate analysis, a within-person variability in diastolic blood pressure of ≥9 mmHg was highly associated with cardiovascular events.
According to Dr. Stojan, the fact that visit-to-visit BPV in patients with lupus was similar to the one seen in stroke cohorts was unexpected. “Its association with multiple factors, such as ethnicity, disease activity, prednisone use, anti-dsDNA positivity, hypocomplementemia and antiphospholipid antibodies, was surprising,” he says. “Patients on hydroxychloroquine had significantly lower blood pressure variability.”
As for the role stress may play in BPV among lupus patients, Dr. Stojan says both basic and clinical data have shown increased blood pressure variability with emotional stress, especially in patients who already have underlying hypertension. “The effect, if any, in lupus would be difficult to discern because the variability is affected by many disease-specific factors, such as disease activity, prednisone use and serologies, as well as patient-specific factors, such as ethnicity, body mass index, etc.,” he says.
What’s Next
Given the relatively small number of cardiovascular events in the patients studied, Dr. Stojan says he would like to see the question of whether blood pressure variability is an independent cardiovascular risk marker in lupus revisited.
“The most important question in my mind is whether we could decrease the cardiovascular risk in lupus by using antihypertensives known to decrease blood pressure variability, such as calcium channel blockers and thiazides,” he says. “We generally use ACE inhibitors as our first choice in lupus due to their benefits in lupus nephritis, but this drug class has been shown not to decrease blood pressure variability in other populations, such as stroke patients.”
Renée Bacher is a frequent contributor to The Rheumatologist and other medical magazines. She is based in Baton Rouge, La.
References
- Stojan G, Magder LS, Petri M. Blood pressure variability and age-related blood pressure patterns in systemic lupus erythematosus. J Rheumatol. 2020 Mar;47(3):387–393.
- Stojan G, Petri M. Atherosclerosis in systemic lupus erythematosus. J Cardiovasc Pharmacol. 2013 Sep;62(3):255–262.
- Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997 Sep;40(9):1725.
- Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277.
- Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of the systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 Aug;64(8):2677–2686.
- Petri M. Hopkins Lupus Cohort. 1999 update. Rheum Dis Clin North Am. 2000 May;26(2):199–213, v.
- Wright JD, Hughes JP, Ostchega Y, et al. Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001–2008. Natl Health Stat Rep. 2011Mar 25;(35)1–22, 24.
