TY - JOUR
T1 - Blood Pressure Variability and Age-related Blood Pressure Patterns in Systemic Lupus Erythematosus
AU - Stojan, George
AU - Magder, Laurence S.
AU - Petri, Michelle
N1 - Funding Information:
From 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. The Hopkins Lupus Cohort is supported by a grant from the US National Institutes of Health (NIH; AR 43727 and 69572). This publication was also made possible by grant number UL1 RR 025005 from the National Center for Research Resources, a component of the NIH, and the NIH Roadmap for Medical Research. Dr. G. Stojan was supported by NIH grant T32 AR048522 and now by AR 69572. G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine. Address correspondence to Dr. G. Stojan, Division of Rheumatology, Johns Hopkins University, 1830 East Monument St., Suite 7500, Baltimore, Maryland 21205, USA. E-mail: gstojan1@jhmi.edu Accepted for publication June 4, 2019.
Publisher Copyright:
Copyright © 2020. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - Antihypertensive agents
KW - Blood Pressure
KW - Hypertension
KW - Systemic Lupus Erythematosus
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U2 - 10.3899/jrheum.181131
DO - 10.3899/jrheum.181131
M3 - Article
C2 - 31203220
AN - SCOPUS:85076292215
VL - 47
SP - 387
EP - 393
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 3
ER -