Campbell J Fallon, Swartz Sarah J, Wenderfer Scott E
Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, 77030, USA.
F1000Res. 2015 Jun 23;4:164. doi: 10.12688/f1000research.6532.2. eCollection 2015.
Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.
高血压是系统性红斑狼疮（SLE）的一个重要表现，但在已发表的成人和儿童患者报告中，患病率在20%至70%之间有所不同。对于患有SLE的儿童和成人，高血压的临床诊断和管理传统上基于为普通人群制定的指南。在临床试验中，用于定义高血压参与者的标准大多未明确。作为正式评估诊断为SLE的儿童血压（BP）模式的第一步，对出现高血压前期或I期高血压的门诊患者的24小时动态血压监测数据进行了分析。在这个儿科SLE队列（n = 10）中，20%符合白天高血压诊断标准。血压升高模式差异很大，发现了白大衣性高血压、隐蔽性高血压、单纯收缩期高血压和夜间舒张期高血压。60%的高血压和血压正常的SLE患者检测到夜间高血压，90%的患者夜间血压下降减弱。在SLE患者中，夜间收缩压和舒张压负荷中位数分别为25%和15.5%，而每日负荷中位数分别为12.5%和11.5%。将白天和夜间的收缩压和舒张压负荷以及夜间血压下降情况与一个由85名21岁以下患有高血压前期或I期高血压并前往高血压门诊就诊的非SLE患者组成的对照人群进行了比较。SLE患者的收缩压中位数下降5.3 mmHg，而非狼疮患者为11.9 mmHg（p值 = 0.001）。SLE患者的舒张压中位数下降12.9 mmHg，而非狼疮患者为18.5 mmHg（p值 = 0.003）。儿科SLE患者的血压调节异常模式值得进一步探索。有或没有SLE且偶然血压测量显示为高血压前期或I期的儿童，通过动态血压监测得出的高血压发生率相似。然而，无论血压诊断如何，且独立于肾脏受累情况，SLE患者中夜间血压下降减弱和夜间高血压的比例都有所增加。
