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Blood Pressure Variability and Age-related Blood Pressure Patterns in Systemic Lupus Erythematosus
George Stojan1,2, Laurence S Magder3,4, Michelle Petri3,4
1From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. gstojan1@jhmi.edu.
Insights
Blood pressure variability in systemic lupus erythematosus (SLE) patients is higher than in the general population and linked to cardiovascular events. Factors like age, race, and disease activity influence this variability.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease is highly prevalent in systemic lupus erythematosus (SLE).
- The interplay between age, blood pressure (BP), and BP variability (BPV) in SLE patients remains unclear.
- Understanding these relationships is crucial for assessing cardiovascular risk in SLE.
Purpose of the Study:
- To investigate visit-to-visit BPV in SLE patients.
- To examine the association of BPV with age, clinical, and demographic factors.
- To determine the role of BPV as a cardiovascular risk factor in SLE.
Main Methods:
- Mixed-effects regression models were used to analyze systolic (SBP) and diastolic BP (DBP) measures.
- Estimates of mean BP and BP variability (SD) were derived.
- BP measures were compared to the general population, and relationships with patient characteristics and CV events were analyzed.
Main Results:
- Mean SBP in SLE patients increased with age and was higher than in the general population, especially in younger individuals.
- BPV was elevated across all ages in SLE patients.
- African Americans, patients with traditional CV risk factors, high disease activity, and those on prednisone showed higher BPV, while hydroxychloroquine was associated with lower BPV.
- Diastolic BP variability of ≥ 9 mmHg was strongly linked to CV events.
Conclusions:
- Age-related BP patterns in SLE differ significantly from the general population.
- Increased visit-to-visit BPV in SLE is influenced by disease-specific and traditional cardiovascular risk factors.
- Elevated diastolic BP variability is a significant predictor of cardiovascular events in SLE patients.
Objective:
Despite the high prevalence of cardiovascular (CV) disease among patients with systemic lupus erythematosus (SLE), the relationship between age, blood pressure (BP), and BP variability (BPV) is not well understood. We studied visit-to-visit BPV, its relationship to age, clinical, and demographic characteristics, and its potential role as a CV risk factor in patients with SLE.
Methods:
We analyzed systolic (SBP) and diastolic BP (DBP) measures in our cohort using mixed-effects regression models. From these models, we then obtained estimates of the mean BP, the visit-to-visit SD, and the between-person SD. The estimated means were compared to the general population using data from the National Health Statistics Reports from 2001 to 2008. In addition, we examined the relationship between BP (means, variances), patient demographic and clinical characteristics, and subsequent CV events.
Results:
The mean SBP in SLE increased with age and was significantly higher in younger patients compared to the general population. BPV in SLE was elevated across all ages. BPV was significantly higher in African Americans, in patients with traditional CV risk factors, those with high disease activity, and in patients taking prednisone. Hydroxychloroquine was associated with significantly lower BPV. Within-person variability in DBP of ≥ 9 mmHg was highly associated with CV events in a multivariate analysis.
Conclusion:
Age-related BP patterns in SLE differ from the general population. Increased visit-to-visit BPV is affected by many disease-specific and traditional CV factors. Increased DBP variability is highly associated with CV events in SLE.
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