Vanderbilt University School of Medicine, Nashville, Tennessee.
Vanderbilt University Medical Center, Nashville, Tennessee.
Arthritis Care Res (Hoboken). 2020 Apr;72(4):534-543. doi: 10.1002/acr.23880.
To compare the risk of resistant hypertension (RHTN) in patients with systemic lupus erythematosus (SLE) and in controls without SLE, and to define factors associated with RHTN in patients with SLE.
We studied 1,044 patients with SLE and 5,241 control subjects using de-identified electronic health records from a tertiary care center. SLE was defined as ≥4 International Classification of Diseases, Ninth Revision codes for SLE and antinuclear antibody titer ≥1:160. RHTN was defined as uncontrolled blood pressure on 3 antihypertensive medications or requiring 4 or more antihypertensives to attain control. First, we compared the risk of RHTN between groups. Second, we examined the association between RHTN and all-cause mortality in patients with SLE.
RHTN was nearly twice as prevalent in patients with SLE compared to control subjects (10.2% and 5.3%, respectively), with an incidence rate of 10.2 versus 6.1 cases per 1,000 person-years of observation (hazard ratio [HR] 1.72 [95% confidence interval 1.28-2.30]; P < 0.001, adjusted for age, sex, race, baseline end-stage renal disease [ESRD], creatinine, and calendar year). In patients with SLE, we found associations between RHTN and black race, lower renal function, hypercholesterolemia, and increased inflammatory markers. RHTN was associated with a significantly higher mortality risk (HR 2.91, P = 0.0005) after adjustment for age, sex, race, calendar year, creatinine, baseline ESRD, and number of visits.
Patients with SLE have a higher risk of RHTN compared to frequency-matched controls, independent of multiple covariates. RHTN is an important comorbidity for clinicians to recognize in SLE, because it is associated with a higher risk of mortality.
比较系统性红斑狼疮（SLE）患者与无 SLE 对照者发生耐药性高血压（RHTN）的风险，并确定 SLE 患者中与 RHTN 相关的因素。
我们使用来自一家三级护理中心的匿名电子健康记录，对 1044 例 SLE 患者和 5241 例对照者进行了研究。SLE 的定义为≥4 个国际疾病分类，第九版 SLE 编码和抗核抗体滴度≥1:160。RHTN 定义为 3 种降压药物控制血压不理想或需要 4 种或更多降压药物才能控制血压。首先，我们比较了两组间 RHTN 的风险。其次，我们检查了 SLE 患者中 RHTN 与全因死亡率之间的关系。
与对照者相比，SLE 患者的 RHTN 患病率几乎高出一倍（分别为 10.2%和 5.3%），观察期间每 1000 人年的发病率分别为 10.2 例和 6.1 例（危险比 [HR] 1.72 [95%置信区间 1.28-2.30]；P<0.001，经年龄、性别、种族、基线终末期肾病 [ESRD]、肌酐和日历年调整）。在 SLE 患者中，我们发现 RHTN 与黑种人、肾功能降低、高胆固醇血症和炎症标志物升高之间存在关联。校正年龄、性别、种族、日历年、肌酐、基线 ESRD 和就诊次数后，RHTN 与死亡率显著升高相关（HR 2.91，P=0.0005）。
与频率匹配对照者相比，SLE 患者发生 RHTN 的风险更高，且独立于多种混杂因素。RHTN 是 SLE 患者临床医生需要识别的重要合并症，因为它与更高的死亡率风险相关。
