African-American and Hispanic ethnicities, renal involvement and obesity predispose to hypertension in systemic lupus erythematosus: results from LUMINA, a multiethnic cohort (LUMINAXLV)

Abstract

Objective: To examine the predictors of the occurrence of hypertension in a large multiethnic US cohort. Patients and methods: There were 614 patients with systemic lupus erythematoses (SLE; >4 American College of Rheumatology revised criteria) with (5 years of disease duration at entry into the cohort (T0) and of Hispanic (Texan or Puerto Rican), African-American or Caucasian ethnicity. T0 variables were compared between patients who did and did not develop hypertension (blood pressure >140/90 mm Hg on at least two occasions and/or the use of antihypertensive drugs) after T0. Significant and clinically relevant variables were then examined by a stepwise logistic regression model. Results: A total of 379 patients without hypertension at T0 were included (patients who developed hypertension prior to SLE diagnosis (n = 126) or before T0 (n = 109) were excluded). Predictors of hypertension were African-American and Texan-Hispanic ethnicities, renal involvement and a higher body mass index. Conclusions: Traditional cardiovascular risk factors, disease-related factors and ethnicity play a role in the occurrence of hypertension in patients with SLE. Controlling renal involvement and optimising body weight may prevent the occurrence of hypertension.I t has been well established that systemic lupus erythematosus (SLE) is associated with an increased risk of cardiovascular disease; compared with the general population, women with SLE have a 5-6-fold increased risk of coronary heart disease and the risk in women aged 35-44 years is approximately 50 times higher. 1 As early as 1976, cardiovascular disease was recognised as a major cause of death, particularly late in the course of SLE. 2 3 Both traditional (age, hypertension, hypercholesterolaemia, obesity, tobacco use and diabetes mellitus) and SLE-related (disease duration, increased C reactive protein levels, the presence of antiphospholipid (aPL) antibodies and glucocorticoid use) factors have been identified as contributors to the occurrence of premature atherosclerosis in SLE. 1 4-6 According to data from the National Health and Nutrition Examination Survey IV, the prevalence of hypertension in the general US population was 15% in 1999-2000. 7 However, hypertension occurs more frequently in patients with SLE than in the general population as evidenced by data from the Hopkins Lupus Cohort (41% and 46% in 1992 and 2000, respectively), 4 8 the Toronto Risk Factor Study (33% vs 13% in age-matched controls) 9 and a study from Vanderbilt University (48% vs 25% in age, gender and ethnic-matched controls). 10 Hypertension is a well-established risk factor for cardiovascular mortality 11 and it has been shown to be a continuous, consistent risk for cardiovascular disease, independent of other risk factors. 12 The association between hypertension and cardiovascular disease, both clinically and subclinically, in SLE had also been confirmed by several studies. 4 5 8 9 13-16 Given the importance of hypertension as a risk factor for cardiovascular morbidity, and possibly mor...

I too, am America: a review of research on systemic lupus erythematosus in African-Americans

“…As previously noted in other studies,21 89–91 hypertension, higher creatinine, proliferative nephritis and decreased GFR,49 50 as well as genetic, environmental and socioeconomic factors,50 92 were associated with ESRD requiring dialysis. Similarly, even when studied separately, African-Americans with SLE continue to display chronic disease risk factors known for the general population (ie, smoking, hypertension, high LDL-c, etc) more frequently,58–60 as observed in other investigations 9394…”

Disparities in lupus care and outcomes

“…LUMINA participants who developed renal disease were younger, had more hypertension and more were African American or Texan Hispanic 31, 42, 43. African American and Texan-Hispanic ethnicity and obesity were also risk factors for developing hypertension in LUMINA46. Abrupt SLE onset, as opposed to a more insidious subacute onset, was associated with younger age, lower SES and predicted more severe ongoing clinical manifestations and higher disease activity40.…”

Understanding mechanisms of hypertension in systemic lupus erythematosus

“…The incidence of hypertension is especially striking in women younger than 40: in one cohort 40% of women under 40 were hypertensive compared with 11% of the control subjects [Sabio et al 2011]. While the pathogenesis of hypertension in SLE is not fully understood [Ryan, 2009], a combination of traditional (age, sex, obesity, ethnicity) and disease-related factors (immune system dysfunction, inflammation, renal involvement, drug side effects) may contribute to hypertension in SLE patients [Sabio et al 2001; Chaiamnuay et al 2007]. Specifically, renal function, the renin–angiotensin system (RAS), sex hormones, inflammatory cytokines, and autoantibodies will be discussed in this review.…”