Background/Purpose:

Hypertension is an independent risk factor for both actual cardiovascular events and also subclinical atherosclerosis (coronary calcium, carotid IMT) in SLE. We examined the factors that predict poorly controlled hypertension in SLE.

Methods: There were 2,182 patients with SLE (92%  female, 56% Caucasian, and 37% African-American).  Ninety-five percent met revised American College of Rheumatology criteria for SLE. Patients were diagnosed as having hypertension if they had systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or if receiving any anti-hypertensive medications.  Patients who had ever had hypertensive episodes during cohort follow-up were compared with patients who had never had hypertension with respect to clinical and demographic characteristics. Multivariate regression modeling using generalized estimating equations was used to assess of the association between various factors and mean systolic blood pressure over cohort follow-up among patients with hypertension.

Results:

There were a total 1630 (74%) patients with hypertension (91% female, 53% Caucasian, 42% African-American).  Compared to non-hypertensive patients, those with hypertension were more likely to be African-American (p<0.0001), male (p=0.0004), smokers (p<0.0001), alcoholic (p<0.0001), older (p<0.0001), lower education (p<0.0001), lower household income (p<0.0001), higher disease activity (p<0.0001), higher body mass index (p<0.0001), higher prednisone dose (p<0.0001),higher urine protein to creatinine ratio (p<0.0001) and higher serum creatinine (p<0.0001).

We next examined, in just the patients with hypertension, the association between clinical variables and systolic blood pressure over followup. In the table, a negative number indicates better control of hypertension.

 

Variable	Effect on Mean Systolic Blood Pressure	p-value
Age at assessment (per year)	0.22±0.03	<0.0001
Gender (female)	-4.56±1.14	<0.0001
Ethnicity
African-American vs Caucasian	3.24±0.91	0.0004
Other ethnicity vs Caucasian	-3.64±1.45	0.012
Years of education (per year)	-0.11±0.14	0.45
Family income (per $1,000)	0.002±0.004	0.63
Smoking	1.19±0.86	0.17
Body mass index (per kg/m2)	0.56±0.05	<0.0001
Number of anti-hypertensives	-3.08±0.35	<0.0001
Prednisone (per mg/d)	0.13±0.02	<0.0001
SELENA-SLEDAI	0.15±0.06	0.017
Urine dipstick protein	0.85±0.40	0.033
Urine protein/cr ratio	2.62±0.41	<0.0001
Serum creatinine	-1.94±0.79	0.014

In the multivariate model, age, male sex, African-American, BMI, prednisone, disease activity, and measures of renal lupus remained independent prediction of poor blood measure control.

Conclusion: Hypertension remains an independent risk factor for cardiovascular events in SLE. As in the general population, older age, male gender, and African-American ethnicity are associated with both hypertension and poor control of hypertension. In SLE, body mass index, prednisone, disease activity, and urine protein to creatinine ratio remain independent predictors of poor blood pressure control. These modifiable risk factors are potential “treat to target” goals. In SLE, use of more than one anti-hypertensive was superior in blood pressure control.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lack-of-control-of-hypertension-in-systemic-lupus-erythematosus/