Abnormal Blood Pressure Patterns May Predict Cardiovascular Disease in Juvenile-onset SLE, Ongoing Study Suggests

Abnormal blood pressure patterns during sleep and overall high blood pressure may independently predict cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus (JSLE), according to a recent update on research supported by the Lupus Foundation of America.

Systemic lupus erythematosus (SLE) patients have an increased risk of cardiovascular disease, one of the leading causes of death in these patients, so early non-invasive detection is important, especially since JSLE — a more severe form than the adult-onset disease — is associated with greater cardiovascular disease risk.

A significant portion of these patients have hypertension, one of the main risk factors for cardiovascular disease, so frequent analysis of blood pressure is also important.

Changes in the blood pressure circadian (daily) cycle, particularly during sleep — when blood pressure naturally declines 10%–20% — have been associated with an increased risk for cardiovascular complications in the general population.

Preliminary results of ongoing research that focused on the development of non-invasive measures of vascular (blood vessel) health in children have now been shared by the Lupus Foundation of America, which funded the work.

The results showed that a smaller-than-normal night-time drop in blood pressure is linked with poor cardiovascular health. However, this reduced night-time drop was not significantly associated with increased blood vessel stiffness, which is an early indicator of cardiovascular disease and is usually higher than normal in lupus patients.

On the other hand, a greater blood pressure load — or the percentage of higher-than-normal blood pressure readings over 24 hours — was associated with higher blood vessel stiffness. This hypertension was not correlated with blood vessel function or heart abnormalities.

These findings suggest that a smaller-than-normal drop in night-time blood pressure and a higher blood pressure load may be linked to two distinct mechanisms of cardiovascular disease risk in JSLE patients.

Leading the research is Joyce Chang, MD, a doctor at the Children’s Hospital of Philadelphia, who received the Gary S. Gilkeson Career Development Award from the Lupus Foundation of America in 2018.

The “award gave me the support to complete a project that I was really passionate about and will serve as the basis for future [National Institute of Health] grants,” Chang said in a news release.