Resistant Hypertension Is Associated with Inflammation, Renal Function, and Increased Mortality in Patients with Systemic Lupus Erythematosus

Jocelyn Gandelman¹, Megan Shuey², April Barnado³, Li Wang⁴, C. Michael Stein³ and Cecilia P. Chung³, ¹Vanderbilt University School of Medicine, Nashville, TN, ²Department of Pharmacology, Vanderbilt University, Nashville, TN, ³Medicine, Vanderbilt University Medical Center, Nashville, TN, ⁴Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Cardiovascular disease, hypertension and renal disease, Lupus, SLE

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Resistant hypertension (RHTN) is defined as blood pressure that remains >140/90 mm Hg despite concurrent use of three different antihypertensive drugs. RHTN has an incidence of 0.7 cases per 100 person-years among patients with hypertension and is associated with a 47% increased risk of cardiovascular events. However, there is no information about RHTN in SLE. Therefore, we estimated the incidence of RHTN in patients with SLE and compared demographic characteristics, immunologic markers, renal function, and mortality in patients who did and did not develop RHTN.

Methods: Patients with SLE were identified from the electronic health records at an academic medical center using a validated algorithm that has a positive predictive value of 94%. The diagnosis of RHTN required the use of 3 antihypertensive drugs concurrently and a mean blood pressure >140/90 mm Hg during the following six months, or the use of ≥ 4 antihypertensive drugs simultaneously. Age, sex, race, immunologic laboratory results, creatinine concentrations at the time of first visit for SLE were compared among patients who developed RHTN and those who did not. Mortality was estimated and compared among patients with and without RHTN during subsequent follow-up.

Results: Of 1,135 patients with SLE identified, 27 were excluded due to pre-existing RHTN present before the first ICD9 code for SLE. Ninety-one patients (8.9%) developed RHTN and 1,017 did not over a follow-up of 7,689 person-years, with an incidence rate of 1.2 cases/100 person-years. Age and sex distribution were similar in patients who developed RHTN and those who did not (Table 1), but patients with RHTN were more likely to be African American (p<0.001), and had lower C3 (p=0.01), higher CRP (p<0.001), higher erythrocyte sedimentation rate (p<0.001), and higher creatinine (p<0.001) at baseline (Table 1). Twenty one patients with resistant hypertension and 111 patients without resistant hypertension died. A logistic regression model indicated higher mortality associated with RHTN [odds ratio: 2.45, (95% CI 1.45-4.14), p<0.001].

Conclusion: Patients with SLE have an incidence rate of RHTN of 1.2 cases/100 person-years, which is higher than that reported in a population of patients with hypertension. RHTN is more frequent in African-American than Caucasian lupus patients and those with low C3 levels, higher inflammatory markers, and increased creatinine. RHTN is associated with increased mortality in patients with SLE.

Table: Patient Characteristics at the time of first ICD9 Code for SLE

	RHTN n=91	No RHTN n=1017	P-value
Demographics
Age,years Female, n (%) Caucasian, n (%) African American, n (%) Race other or unknown, n (%)	42 [22-56] 82 (90.1%) 43 (47.3%) 43 (47.3%) 5 (5.5%)	39 [27-51] 914 (89.9%) 702 (69.0%) 231 (22.7%) 84 (8.3%)	0.59 0.94 <0.001
Immunologic markers
C3, mg/dl C4 ,mg/dl CRP, mg/L ESR, mm/hr	96 [69-123] 19 [14-28] 10.4 [2.8-41.7] 40 [18-78]	111 [82-132] 20 [12-28] 3.5 [1.0-12.2] 25 [10-49]	0.01 0.62 <0.001 <0.001
Creatinine (mg/dl)	1.0 [0.8-1.6]	0.8 [0.7-1.0]	<0.001

*Data were analyzed using chi-squared tests for categorical variables and Wilcoxon’s rank sum test for continuous variables. P<.05 was considered significant.

** The total SLE population was n= 1108, unless otherwise noted for the following variables: C3 (n=1007), C4 (n=914), CRP (n=757), ESR (n=947), Creatinine (n=1090)

Disclosure: J. Gandelman, None; M. Shuey, None; A. Barnado, None; L. Wang, None; C. M. Stein, Lupus Research Alliance, 2; C. P. Chung, NIH/NIAMS and Rheumatology Research Foundation, 2.

To cite this abstract in AMA style:

Gandelman J, Shuey M, Barnado A, Wang L, Stein CM, Chung CP. Resistant Hypertension Is Associated with Inflammation, Renal Function, and Increased Mortality in Patients with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/resistant-hypertension-is-associated-with-inflammation-renal-function-and-increased-mortality-in-patients-with-systemic-lupus-erythematosus/. Accessed .

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