系统性红斑狼疮（SLE）患者的高血压治疗模式和控制情况：一项横断面研究。

Treatment patterns and control of hypertension in systemic lupus erythematosus (SLE): a cross-sectional study.

机构信息

Department of Medicine, McGill University, Montreal, Quebec, Canada.

Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

BMJ Open. 2021 Nov 1;11(11):e048384. doi: 10.1136/bmjopen-2020-048384.

DOI:10.1136/bmjopen-2020-048384

PMID:34725073

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8562504/

Abstract

OBJECTIVE

Hypertension (HTN) is common in systemic lupus erythematosus (SLE), representing a key risk factor for cardiovascular and renal disease. We described HTN treatment patterns in SLE, evaluated uncontrolled HTN according to Canadian and American guidelines and identified factors associated with uncontrolled HTN.

METHODS

We performed a cross-sectional study, identifying all McGill Lupus Clinic registry patients with an annual visit between January 2017 and May 2019 who were taking HTN medications. We excluded those taking medications only for another indication (eg, Raynaud's). We determined the frequency of uncontrolled HTN according to Canadian and American College of Cardiology/American Heart Association guidelines. Multivariate logistic regression (adjusted for age, sex and race/ethnicity) evaluated if uncontrolled HTN was more common with high body mass index (BMI), longer SLE duration, high disease activity, renal damage, multiple concomitant antihypertensives, prednisone and non-steroidal anti-inflammatory drugs.

RESULTS

Of 442 patients with SLE, 108 were taking medications to treat HTN, and 38 took multiple medications concurrently. Angiotensin-receptor blockers were most common, followed by calcium channel blockers, diuretics, angiotensin-converting enzyme inhibitors and beta blockers. Among the 108 patients, 39.8% (n=43) had blood pressure (BP) >140/90 mm Hg, while 66.7% (n=72) had BP >130/80 mm Hg. In multivariate analyses, uncontrolled HTN (>130/80 mm Hg) was more likely in Caucasians (OR 2.72, 95% CI 1.12 to 6.78) and patients with higher BMI (OR 1.08, 95% CI 1.00 to 1.19). Patients with renal damage had better HTN control (OR 0.39, 95% CI 0.16 to 0.97). We could not draw definitive conclusions regarding other variables.

CONCLUSION

Caucasians and patients with higher BMI had more uncontrolled HTN. The negative association with renal damage is reassuring, as controlled BP is key for renal protection.

摘要

目的

高血压（HTN）在系统性红斑狼疮（SLE）中很常见，是心血管和肾脏疾病的关键危险因素。我们描述了 SLE 中 HTN 的治疗模式，根据加拿大和美国的指南评估了未控制的 HTN，并确定了与未控制的 HTN 相关的因素。

方法

我们进行了一项横断面研究，确定了 2017 年 1 月至 2019 年 5 月期间在麦吉尔狼疮诊所登记的每年就诊且正在服用 HTN 药物的所有患者。我们排除了仅因其他原因（如雷诺现象）而服用药物的患者。我们根据加拿大和美国心脏病学会/美国心脏协会的指南确定了未控制的 HTN 的频率。多变量逻辑回归（调整年龄、性别和种族/民族）评估了未控制的 HTN 是否更常见于高体重指数（BMI）、SLE 持续时间更长、疾病活动度更高、肾脏损伤、同时服用多种降压药、泼尼松和非甾体抗炎药。

结果

在 442 例 SLE 患者中，有 108 例服用药物治疗 HTN，38 例同时服用多种药物。血管紧张素受体阻滞剂最常见，其次是钙通道阻滞剂、利尿剂、血管紧张素转换酶抑制剂和β受体阻滞剂。在 108 例患者中，39.8%（n=43）的血压（BP）>140/90mmHg，66.7%（n=72）的血压>130/80mmHg。在多变量分析中，白人（OR 2.72，95%CI 1.12 至 6.78）和 BMI 较高的患者（OR 1.08，95%CI 1.00 至 1.19）发生未控制的 HTN 的可能性更大。有肾脏损伤的患者血压控制更好（OR 0.39，95%CI 0.16 至 0.97）。我们无法对其他变量得出明确的结论。