Diastolic Blood Pressure Variability Linked to CV Events in SLE

Elevated diastolic blood pressure variability (BPV) in patients with systemic lupus erythematosus (SLE) was predictive of subsequent cardiovascular events, according to study results published in the Journal of Rheumatology.

Investigators abstracted data from the Hopkins Lupus Cohort, a prospective cohort study of patients with SLE. Enrolled patients attended baseline and quarterly follow-up visits at which clinical features, laboratory testing, and damage accrual data were recorded. The present study used mixed effects regression models to analyze systolic and diastolic blood pressure measures among patients. The impact of blood pressure on patient demographics, clinical characteristics, and subsequent cardiovascular events was also assessed. Patient blood pressure values were then compared with those of the general population using data from the 2001 to 2008 National Health Statistics Reports.

Among patients with SLE and the general population, mean systolic blood pressure (SBP) increased with age. However, SBP was significantly higher among young patients with SLE (age 18-39 years) compared with their counterparts in the general population (117.9 vs 109; P <.0001). BPV was elevated for patients with SLE in all age brackets.

Among the SLE cohort, BPV was significantly higher among black patients, patients with high disease activity, and patients with traditional cardiovascular risk factors, including hypercholesterolemia, diabetes, and current smoking habits (all P <.0001). BPV increased with prednisone dose and was significantly higher in patients taking >12.5 mg/d compared with patients taking smaller doses (P <.0001). Hydroxychloroquine was associated with significantly lower BPV (P <.0001).

In the adjusted multivariate analysis, patients with diastolic blood pressure variability of ≥9 mm Hg were more likely to experience cardiovascular events (relative risk, 2.1; 95% CI, 1.0-4.1; P <.05).

Blood pressure variability in SLE was thus influenced both by disease-specific factors and traditional cardiovascular risk factors. Treatment for patients with SLE should incorporate strict blood pressure monitoring to minimize risk for cardiovascular events.

Reference

Stojan G, Magder LS, Petri M. Blood pressure variability and age-related blood pressure patterns in systemic lupus erythematosus [published online June 15, 2019]. J Rheumatol. doi:10.3899/jrheum.181131