Blood pressure control over time in childhood-onset systemic lupus erythematous

Abstract

Introduction Hypertension (HTN) is prevalent in patients with systemic lupus erythematosus (SLE) and causes early cardiovascular aging and progression of renal and cardiac disease. The aim of this longitudinal retrospective study was to evaluate the prevalence of HTN, the follow-up blood pressure trends, and risk factors for HTN in a population-based cohort with childhood-onset SLE (cSLE). Methods Demographic and clinical data of consecutive visits from the baseline to the last visit were extracted from electronic medical records of patients with cSLE. Results A total of 110 patients with cSLE were identified with a median follow-up duration of 29.5 months; 19% had lupus nephritis (LN) at diagnosis. Further, 29% and 23% had HTN and preHTN at the baseline visit. Compared to those without HTN, patients with HTN had higher disease activity, obesity, more frequent LN, and lower eGFR. In multivariate analysis, the presence of LN, obesity, and high extra-renal disease activity were independent predictors of HTN at baseline. Conclusions While HTN is a known feature of LN, HTN is common and persistent in cSLE without LN, with about one-third of patients having uncontrolled elevated blood pressure almost three years after the onset of lupus. In addition to LN, obesity and high overall disease activity were independent predictors of HTN.

Autoimmune Disease-Associated Hypertension

“…The renal injury per se that is caused by nephritis is likely not the cause of the hypertension. This is supported by studies showing that hypertension is prevalent in child-onset SLE independent of the presence of nephritis [91]. In addition, Shaharir et al found that 53% of SLE patients were hypertensive without evidence of nephritis [20].…”

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

“…A recent study reported arterial hypertension in approximately one-third of cSLE patients, almost 3 years after the disease onset. In multivariate analysis, lupus nephritis, obesity, and high frequency of extra-renal disease activity were independent predictors of arterial hypertension at baseline [ 123 ]. Prompt adjuvant treatment of arterial hypertension and proteinuria should be recommended for all cSLE patients [ 96 ].…”

Longitudinal Changes in Cardiac Structure and Function in Pediatric Kidney Transplant Recipients

“…Controlled blood pressure was defined as individuals both on ≥1 antihypertensive medication and with blood pressure less than the 90th percentile referenced to sex, height, and age. 25,26 Uncontrolled blood pressure was defined as individuals on ≥1 medications with readings greater than the 90th percentile referenced to sex, height, and age. Antihypertensive medications were categorized as angiotensin-converting enzyme inhibitors, calcium channel blockers, or other, which included β-blockers, α-blockers, angiotensin receptor blockers, diuretics, and vasodilators.…”

“…Controlled blood pressure was defined as individuals both on ≥1 antihypertensive medication and with blood pressure less than the 90th percentile referenced to sex, height, and age. 25,26 Uncontrolled blood pressure was defined as individuals on ≥1 medications with readings greater than the 90th percentile referenced to sex, height, and age.…”