In the Journals

Resistant hypertension twice as common in patients with SLE

Cecilia P. Chung

Resistant hypertension is nearly twice as prevalent among patients with systemic lupus erythematosus than in the general population, according to recent findings in Arthritis Care & Research.

“Increasing evidence indicates that traditional cardiovascular risk factors and markers of inflammation do not fully explain the greater risk of coronary artery disease among patients with SLE,” Cecilia P. Chung, MD, MPH, of the Vanderbilt University Medical Center, and colleagues wrote. “One novel risk factor — resistant hypertension — carries a 44% increased rate of coronary artery disease, 57% increased rate of stroke, and 30% increased rate of all-cause mortality in the general population.”

They added, “Despite the recognition that [resistant hypertension] increases cardiovascular risk substantially in the general population, there is no information regarding the incidence, prevalence, and associated factors in patients with SLE or its consequences in routine clinical practice.”

 
Resistant hypertension is nearly twice as prevalent among patients with SLE than in the general population, according to recent findings.
Source: Adobe

To compare the risk for resistant hypertension in patients with SLE with healthy controls, and to characterize the factors linked to patients with both conditions, Chung and colleagues studied anonymized data from the electronic medical records at Vanderbilt University Medical Center. Focusing on the years between 1989 and 2017, the researchers identified 1,044 patients with SLE, and matched them to 5,241 control individuals based on age, race and sex.

Members of the control group included medical center patients without autoimmune disease who made three outpatient visits within 5 years of their first visit. The researchers defined SLE as four or more codes for the disease and an antinuclear antibody titer of 1:160 or greater. Resistant hypertension was defined as a patient demonstrating uncontrolled blood pressure despite treatment with three antihypertensives, or requiring four or more antihypertensives to achieve control. The researchers assessed the risk for resistant hypertension, as well as its association with mortality, in both groups.

According to the researchers, the prevalence of resistant hypertension was 10.2% in patients with SLE, compared with 5.3% among the control group. Incidence rates for resistant hypertension were 10.2 and 6.1 per 1,000 person-years for the SLE and control groups respectively (HR = 1.72; 95% CI, 1.28-2.3).

“We found that resistant hypertension is twice as common in patients with lupus compared to those without lupus,” Chung told Healio Rheumatology. “In our study, lupus patients with resistant hypertension had worse clinical outcomes than other lupus patients.”

Among patients with SLE, resistant hypertension was associated with black race, lower renal function, hypercholesterolemia and increased inflammatory markers. In addition, resistant hypertension was linked to a significantly higher risk for mortality (HR = 2.91; 95% CI, 1.6-5.29).

“Our study emphasizes the importance of diagnosing and treating high blood pressure in patients with lupus,” Chung said. “It also shows that blood pressure can be difficult to control for many patients with lupus.” – by Jason Laday

Disclosure: Chung reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

Cecilia P. Chung

Resistant hypertension is nearly twice as prevalent among patients with systemic lupus erythematosus than in the general population, according to recent findings in Arthritis Care & Research.

“Increasing evidence indicates that traditional cardiovascular risk factors and markers of inflammation do not fully explain the greater risk of coronary artery disease among patients with SLE,” Cecilia P. Chung, MD, MPH, of the Vanderbilt University Medical Center, and colleagues wrote. “One novel risk factor — resistant hypertension — carries a 44% increased rate of coronary artery disease, 57% increased rate of stroke, and 30% increased rate of all-cause mortality in the general population.”

They added, “Despite the recognition that [resistant hypertension] increases cardiovascular risk substantially in the general population, there is no information regarding the incidence, prevalence, and associated factors in patients with SLE or its consequences in routine clinical practice.”

 
Resistant hypertension is nearly twice as prevalent among patients with SLE than in the general population, according to recent findings.
Source: Adobe

To compare the risk for resistant hypertension in patients with SLE with healthy controls, and to characterize the factors linked to patients with both conditions, Chung and colleagues studied anonymized data from the electronic medical records at Vanderbilt University Medical Center. Focusing on the years between 1989 and 2017, the researchers identified 1,044 patients with SLE, and matched them to 5,241 control individuals based on age, race and sex.

Members of the control group included medical center patients without autoimmune disease who made three outpatient visits within 5 years of their first visit. The researchers defined SLE as four or more codes for the disease and an antinuclear antibody titer of 1:160 or greater. Resistant hypertension was defined as a patient demonstrating uncontrolled blood pressure despite treatment with three antihypertensives, or requiring four or more antihypertensives to achieve control. The researchers assessed the risk for resistant hypertension, as well as its association with mortality, in both groups.

According to the researchers, the prevalence of resistant hypertension was 10.2% in patients with SLE, compared with 5.3% among the control group. Incidence rates for resistant hypertension were 10.2 and 6.1 per 1,000 person-years for the SLE and control groups respectively (HR = 1.72; 95% CI, 1.28-2.3).

“We found that resistant hypertension is twice as common in patients with lupus compared to those without lupus,” Chung told Healio Rheumatology. “In our study, lupus patients with resistant hypertension had worse clinical outcomes than other lupus patients.”

Among patients with SLE, resistant hypertension was associated with black race, lower renal function, hypercholesterolemia and increased inflammatory markers. In addition, resistant hypertension was linked to a significantly higher risk for mortality (HR = 2.91; 95% CI, 1.6-5.29).

“Our study emphasizes the importance of diagnosing and treating high blood pressure in patients with lupus,” Chung said. “It also shows that blood pressure can be difficult to control for many patients with lupus.” – by Jason Laday

Disclosure: Chung reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.