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Nighttime Blood Pressure Patterns and Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus
José Mario Sabio1, Josefina Martinez-Bordonado2, Isabel Sánchez-Berná2
1From the Systemic Autoimmune Diseases Unit, Department of Internal Medicine, and Hypertension and Lipids Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; Department of Statistics, Investigación Biosanitaria de Andalucía Oriental Foundation, Granada, Spain.J.M. Sabio, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J. Martinez-Bordonado, MD, Research Fellow, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; I. Sánchez-Berná, MD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J.A. Vargas-Hitos, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J.D. Mediavilla, MD, PhD, Hypertension and Lipids Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; N. Navarrete-Navarrete, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; M. Zamora-Pasadas, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; M.E. Ruíz, MD, Department of Statistics, Investigación Biosanitaria de Andalucía Oriental Foundation; J. Jiménez-Alonso, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves. jomasabio@gmail.com.
Objective:
To compare 24-h ambulatory blood pressure (BP) monitoring (ABPM) values and patterns in women with systemic lupus erythematosus (SLE) with those of a matched control group and their relationship with the presence of subclinical atherosclerosis.
Methods:
ABPM was assessed in 70 women with SLE and in 65 sex- and age-matched controls without a history of clinic cardiovascular disease (CVD). Carotid-femoral pulse wave velocity (PWV), which is a marker of subclinical atherosclerosis and a predictor of future CVD, was measured. Multivariate logistic analysis was used to determine which explanatory variables were independently associated with the non-dipper pattern and the presence of nocturnal hypertension (HTN) in women with SLE.
Results:
No differences in PWV were found between patients and controls [median 7.3, interquartile range (IQR) 6.5-8.1 m/s vs median 7.1, IQR 6.5-7.8 m/s, p = 0.474]. The frequency of nondipper pattern (p = 0.025) and nocturnal HTN (p = 0.004) was significantly higher in women with SLE than in controls. White-coat and masked HTN were present in 10% and 11% of patients and in 20% and 8% of controls, respectively (p > 0.05 in all cases). The concordance between office and ambulatory HTN in the SLE and control groups was modest (κ = 0.325 and κ = 0.451, respectively). PWV and chronic kidney disease, and PWV and the Systemic Lupus Erythematosus Disease Activity Index were found to be independently associated with nocturnal HTN and nondipper pattern, respectively.
Conclusion:
Women with SLE were more likely to have an altered nighttime BP pattern than controls. In women with SLE, nondipper pattern and nocturnal HTN were independently associated with increased subclinical atherosclerosis measured by PWV.
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