Abstract
Arterial hypertension (HPT) burden up to two third of systemic lupus erythematosus (SLE) patients and contributes to accelerated atherosclerosis and cardiovascular (CV) risk. We aim to determine the prevalence of HPT among lupus nephritis (LN) patients who were in complete remission (CR) for a minimum of 6 months, with estimated glomerular filtration rate (eGFR) of >60 mL/min/1.73 m2. This is a cross-sectional study of 64 LN patients who attended Nephrology/SLE Clinic at The National University of Malaysia Medical Centre (UKMMC). Persistent hypertension (blood pressure (BP) ≥140/90 mmHg for at least two occasions), CR for a minimum of 6 months and eGFR of >60 mL/min/1.73 m2 were identified. Univariate and multivariate analyses were performed to determine the demographic and disease characteristics associated with HPT. Thirty-four of them (53.1 %) were hypertensive. Persistent HPT was associated with disease duration, acute kidney injury and high BP at the onset of LN, longer duration interval to achieve CR, number of relapses and cyclosporine A (CyA) use. There were no associations between histological classes, nephrotic range proteinuria, body mass index and waist circumference with HPT. Factors independently associated with HPT were disease duration OR 1.06 [95 %CI (0.91–1.24)], longer duration interval to achieve CR OR 1.104 [95 %CI (1.02–1.19)], number of relapses OR 2.53 [95 % CI (1.01–6.3)] and CyA use OR 5.3 [95 % CI (1.14–23.9)]. The prevalence of HPT among LN is high despite in remission. Aggressive treatment is important to achieve early CR and to prevent relapses.
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References
Iaccarino L, Bettio S, Zen M, Nalotto L, Gatto M et al (2013) Premature coronary heart disease in SLE: can we prevent progression? Lupus 22:1232–1242
Thompson T, Sutton-Tyrrell K, Wildman RP, Kao A, Fitzgerald SG et al (2008) Progression of carotid intima-media thickness and plaque in women with systemic lupus erythematosus. Arthritis Rheum 58:835–842
Al-Herz A, Ensworth S, Shojania K, Esdaile JM (2003) Cardiovascular risk factor screening in systemic lupus erythematosus. J Rheumatol 30:493–496
Budman DR, Steinberg AD (1976) Hypertension and renal disease in systemic lupus erythematosus. Arch Intern Med 136:1003–1007
Mandell BF (1987) Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum 17:126–141
Petri M (2000) Detection of coronary artery disease and the role of traditional risk factors in the Hopkins Lupus Cohort. Lupus 9:170–175
Mitchell GF, Guo CY, Kathiresan S, Vasan RS, Larson MG et al (2007) Vascular stiffness and genetic variation at the endothelial nitric oxide synthase locus: the Framingham Heart study. Hypertension 49:1285–1290
Ryan MJ (2009) The pathophysiology of hypertension in systemic lupus erythematosus. Am J Physiol Regul Integr Comp Physiol 296:R1258–R1267
Maxwell SR, Moots RJ, Kendall MJ (1994) Corticosteroids: do they damage the cardiovascular system? Postgrad Med J 70:863–870
Sazliyana S, Mohd Shahrir MS, Kong CT, Tan HJ, Hamidon BB et al (2011) Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients. Lupus 20:1260–1266
Ryan MJ, McLemore GR Jr (2007) Hypertension and impaired vascular function in a female mouse model of systemic lupus erythematosus. Am J Physiol Regul Integr Comp Physiol 292:R736–R742
Nakano M, Ueno M, Hasegawa H, Watanabe T, Kuroda T et al (1998) Renal haemodynamic characteristics in patients with lupus nephritis. Ann Rheum Dis 57:226–230
Tareeva IE, Shvetsov M, Krasnova TN, Kutyrina IM, Nasonov EL et al (1997) Arterial hypertension in lupus nephritis. Ter Arkh 69:13–17
Garcia-Gonzalez A, Gonzalez-Lopez L, Valera-Gonzalez IC, Cardona-Munoz EG, Salazar-Paramo M et al (2002) Serum leptin levels in women with systemic lupus erythematosus. Rheumatol Int 22:138–141
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Grootscholten C, Ligtenberg G, Hagen EC, van den Wall Bake AW, de Glas-Vos JW et al (2006) Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. Randomized Control Trial Kidney Int 70:732–742
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) ExpertPanel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults JAMA. 2001;285(19):2486–2497. doi:10.1001/jama.285.19.2486
Wang F, Wang CL, Tan CT, Manivasagar M (1997) Systemic lupus erythematosus in Malaysia: a study of 539 patients and comparison of prevalence and disease expression in different racial and gender groups. Lupus 6:248–253
Swaak AJ, van den Brink HG, Smeenk RJ, Manger K, Kalden JR et al (1999) Systemic lupus erythematosus: clinical features in patients with a disease duration of over 10 years, first evaluation. Rheumatology 38:953–958
Rosenbaum JL, Akhtar M, Kramer MS, Raja RM, Manchanda R et al (1974) Evaluation of clearance studies in lupus nephritis. Clin Nephrol 2:47–51
Faurschou M, Starklint H, Halberg P, Jacobsen S (2006) Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol 33:1563–1569
Kammoun K, Jarraya F, Bouhamed L, Kharrat M, Makni S et al (2011) Poor prognostic factors of lupus nephritis. Saudi J kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 22:727–732
Mok CC, Wong RW, Lau CS (1999) Lupus nephritis in Southern Chinese patients: clinicopathologic findings and long-term outcome. Am J Kidney Dis Off J Natl Kidney Found 34:315–323
Fiehn C, Hajjar Y, Mueller K, Waldherr R, Ho AD et al (2003) Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment. Ann Rheum Dis 62:435–439
Petrin J, Rozman B, Dolenc P, Logar D, Bozic B et al (1993) The dissociation of arterial hypertension and lupus glomerulonephritis in systemic lupus erythematosus. Blood Press 2:108–112
Ward MM, Studenski S (1992) Clinical prognostic factors in lupus nephritis. The importance of hypertension and smoking. Arch Intern Med 152:2082–2088
Weidle PJ, Vlasses PH (1988) Systemic hypertension associated with cyclosporine: a review. Drug Intell Clin Pharm 22:443–451
Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol JASN 10:413–424
Clyburn EB, DiPette DJ (1995) Hypertension induced by drugs and other substances. Semin Nephrol 15:72–86
Clancy RM (2000) Circulating endothelial cells and vascular injury in systemic lupus erythematosus. Curr Rheumatol Rep 2:39–43
Acknowledgments
The authors would like to thank Prof. Dr Raymond Azman Ali, Director and Dean National University of Malaysia Medical Centre.
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None of the authors had any conflict of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included in this manuscript.
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Shaharir, S.S., Mustafar, R., Mohd, R. et al. Persistent hypertension in lupus nephritis and the associated risk factors. Clin Rheumatol 34, 93–97 (2015). https://doi.org/10.1007/s10067-014-2802-0
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DOI: https://doi.org/10.1007/s10067-014-2802-0