Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus

Arthritis Research & Therapy

Rui Xiao¹  Kevin E. Meyers²  Shobha S. Natarajan²  Laura Mercer-Rosa²  Pamela F. Weiss³  Joyce C. Chang³  Andrea M. Knight⁴ 

[1] Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine;Department of Pediatrics, University of Pennsylvania Perelman School of Medicine;Division of Rheumatology, Children’s Hospital of Philadelphia;Division of Rheumatology, Hospital for Sick Children;

关键词: Systemic lupus erythematosus;    Pediatric systemic lupus erythematosus;    Ambulatory blood pressure monitoring;    Cardiovascular disease;    Cardiovascular diagnostic techniques;   

DOI  :  10.1186/s13075-020-02224-w

来源: DOAJ

【 摘 要 】

Abstract Background Loss of the normal nocturnal decline in blood pressure (BP), known as non-dipping, is a potential measure of cardiovascular risk identified by ambulatory blood pressure monitoring (ABPM). We sought to determine whether non-dipping is a useful marker of abnormal vascular function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus (pSLE). Methods Twenty subjects 9–19 years of age with pSLE underwent ABPM, peripheral endothelial function testing, carotid-femoral pulse wave velocity/analysis for aortic stiffness, and carotid intima-media thickness. We assessed the prevalence of non-dipping and other ABPM abnormalities. Pearson or Spearman rank correlation tests were used to evaluate relationships between nocturnal BP dipping, BP load (% of abnormally elevated BPs over 24-h), and vascular outcome measures. Results The majority (75%) of subjects had inactive disease, with mean disease duration of 3.2 years (± 2.1). The prevalence of non-dipping was 50%, which occurred even in the absence of nocturnal or daytime hypertension. Reduced diastolic BP dipping was associated with poorer endothelial function (r 0.5, p = 0.04). Intima-media thickness was significantly greater in subjects with non-dipping (mean standard deviation score of 3.0 vs 1.6, p = 0.02). In contrast, higher systolic and diastolic BP load were associated with increased aortic stiffness (ρ 0.6, p = 0.01 and ρ 0.7, p < 0.01, respectively), but not with endothelial function or intima-media thickness. Conclusion In a pSLE cohort with low disease activity, isolated nocturnal BP non-dipping is prevalent and associated with endothelial dysfunction and atherosclerotic changes. In addition to hypertension assessment, ABPM has a promising role in risk stratification and understanding heterogeneous mechanisms of cardiovascular disease in pSLE.

【 授权许可】

Unknown