Session Type: Abstract Submissions (ACR)
Background/Purpose: Increased visit-to-visit blood pressure (BP) variability has been associated with an increased risk of all-cause mortality, stroke, left ventricular diastolic dysfunction, and cognitive impairment among diverse populations. Despite the high prevalence of cardiovascular disease among patients with systemic lupus erythematosus (SLE), BP variability and the relationship between age, BP and BP variability has not been described in this population.
Methods: The means and variances of systolic and diastolic pressures in the general population using data from the National Health Statistics Reports (19,921 adults aged 18 and over with BP estimates calculated using the mean of up to three measurements) were compared with those in a cohort of SLE patients (1340 different patients, seen quarterly, with an average duration of follow-up of 74 months). The following variables were calculated: mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), and within-person standard deviation of SBP and DBP.
Results: The systolic BP in SLE follows the trend of increase with age seen in the general population, but was statistically significantly higher in young adults 18-39 years of age (p<0.001) regardless of sex and race. Surprisingly, with age this trend decreased and in females older than 60 years of age it reversed, with SLE patients having a statistically significantly lower SBP compared to the general population (p<0.001). Diastolic BP was statistically significantly (p<0.001) elevated among female SLE patients across all age groups with the exception of Caucasian women 40-59 years of age. Among males, we observed higher DBP in our SLE males compared to the general population in all age/ethnic groups, however, the differences were not all statistically significant, due to the low number of males in the cohort. BP variability in SLE is elevated across all age groups. Within person standard deviation (SD) of SBP increased with age and ranged between 12.2 mmHg among 20 year olds and 16.7 mmHg among 80 year olds, while DBP variability remained stable through all age groups and ranged between 8.7 mmHg and 8.9 mmHg. These values are substantially higher than the within-person BP variability reported by NHANES which is 7.7 mmHg for SBP and 5.8 mmHg for DBP, but is comparable to previously published data in stroke cohorts (UK-TIA, Dutch TIA, ESPS-1 trials).
Conclusion: The relationship of BP to age in SLE differs from that in the general population with significantly higher mean SBP among young adults and lower mean SBP among elderly females. BP variability in SLE is elevated across all age groups compared to the general population and is comparable to the variability seen in stroke cohorts. Consistent available data obtained in a wide spectrum of non-SLE populations (from a general population to high-risk patients) show an association between increased visit-to-visit BP variability and worse cardiovascular outcomes and target organ damage. Further studies are needed to determine the causes of visit-to-visit BP variability in SLE, its association with cardiovascular outcomes, and whether treatments that reduce BP variability may improve cardiovascular outcomes.
L. S. Magder,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/blood-pressure-variability-and-age-related-blood-pressure-patterns-in-systemic-lupus-erythematosus/