Background/Purpose: Cardiovascular disease (CVD) is the leading cause of increased long-term morbidity and mortality in systemic lupus erythematosus (SLE). As an important modifiable risk factor for CVD, hypertension (HTN) is prevalent in patients with SLE and causes early cardiovascular aging and progression of the renal and cardiac disease. The aims of this longitudinal retrospective study were to determine the prevalence of HTN, evaluate longitudinal trend in blood pressure control, and assess risk factors for HTN in childhood-onset SLE (cSLE).

Methods: Between January 2012 and December 2016, demographic and clinical data of consecutive visits including sitting blood pressure, disease activity as measured by the SLE disease activity index (SLEDAI), presence of lupus nephritis, medication use, and results of the standard laboratory testing from cSLE diagnosis to the last visit were extracted from medical records of patients with cSLE admitted to the rheumatology clinic.

Results: 110 patients with cSLE were recruited: 79% female; 35% blacks; mean age at the baseline visit 13.3 ± 3.0 years; median follow-up duration 29.5 months; 19% had lupus nephritis. Twenty-nine percent of patients had HTN and 23% had pre-hypertension at the baseline visit. Patients with HTN had higher disease activity, more frequent renal involvement, lower eGFR, and were more obese than patients without HTN. In the multivariate analysis, the presence of nephritis, obesity, and high extra-renal disease activity (SLEDAI score ≥ 10) were independent predictors of HTN at the baseline. No significant changes in blood pressure control were observed in patients without nephritis. Patients with nephritis had less stage 1 and 2 HTN, and more prehypertension at the last follow-up compared to the baseline.

Conclusion: While hypertension is known feature of lupus nephritis, our results indicate that hypertension is common and persistent in cSLE without kidney disease with about one third of patients having uncontrolled elevated BP almost 3 years after onset of lupus. In addition to renal disease, obesity and high overall disease activity were identified as independent predictors of HTN in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/blood-pressure-control-over-time-in-childhood-onset-systemic-lupus-erythematous/