Zengin Oğuzhan, Soytürk Gülşah, Göre Burak, Yürümez Mustafa, Kurtipek Ali Can, Kalkan Emra Asfuroğlu, Konak Hatice Ecem, Erten Şükran, Ateş Ihsan
Department of Internal Medicine, University of Health Sciences, Ankara Bilkent City Hospital, 06800 Ankara, Turkey.
Department of Rheumatology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey.
J Pers Med. 2025 Jun 15;15(6):253. doi: 10.3390/jpm15060253.
In systemic sclerosis (SSc), endothelial dysfunction, inflammation, and reduced nitric oxide levels may disrupt circadian blood pressure (BP) regulation. There are studies showing that inflammatory and certain other cells in diseases like SSc exhibit diurnal rhythms. In our study, we examined the effect of SSc on BP. In particular, the frequency of the non-dipper pattern (lack of nighttime BP reduction) in SSc patients has not been adequately investigated. The aim of this study was to evaluate the 24 h BP profile in SSc patients and to compare the frequency of the non-dipper pattern with that of the non-scleroderma group. Additionally, the identification of disrupted circadian BP patterns in SSc patients aims to contribute to the development of personalized, time-sensitive BP monitoring strategies in the future and to support the applicability of personalized medicine in this context. A total of 31 SSc patients diagnosed according to the 2013 ACR/EULAR classification criteria and 30 age- and sex-matched individuals without SSc were included in this prospective study. BP changes between day and night were evaluated by measuring BP every 30 min with a 24 h ambulatory blood pressure monitoring (ABPM) device. The non-dipper pattern was defined as a decrease in BP of less than 10% during the night compared to the day. To better assess BP fluctuations during the night, nighttime measurements were divided into two time periods: first, 24:00-04:00, and then 04:00-08:00. Additionally, laboratory and clinical parameters and SSc subtypes were compared between the groups. The ABPM findings were compared between the groups with and without SSc. The non-dipper pattern was significantly more common in the SSc group at all time intervals. The non-dipper pattern was observed in 25.8% of the non-SSc group and 83.9% of SSc patients ( < 0.001). In the period between 24:00 and 04:00, the prevalence was 25.8% in the control group and 71.0% in SSc patients ( < 0.001), and between 04:00 and 08:00, it was 35.5% in the control group and 80.6% in SSc patients ( < 0.001). No significant difference was found in non-dipper patterns between individuals with diffuse and limited cutaneous forms of systemic sclerosis. The non-dipper BP pattern is significantly more common in patients with SSc, indicating the disruption of the circadian rhythm affecting BP. Analysis performed by dividing the night into specific time periods revealed that this deterioration continued throughout the night. The findings highlight the importance of circadian BP monitoring in SSc patients and may contribute to future risk stratification and treatment strategies. Circadian BP analysis in SSc may help to develop strategies that are personalized for these patients and tailored to their physiological rhythm.
在系统性硬化症（SSc）中，内皮功能障碍、炎症以及一氧化氮水平降低可能会扰乱昼夜血压（BP）调节。有研究表明，在诸如SSc等疾病中，炎症细胞和某些其他细胞呈现昼夜节律。在我们的研究中，我们检测了SSc对血压的影响。特别是，SSc患者中无勺型模式（夜间血压未降低）的频率尚未得到充分研究。本研究的目的是评估SSc患者的24小时血压概况，并将无勺型模式的频率与非硬皮病组进行比较。此外，识别SSc患者中昼夜血压模式的紊乱旨在为未来制定个性化的、对时间敏感的血压监测策略做出贡献，并支持个性化医疗在这种情况下的适用性。根据2013年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）分类标准诊断的31例SSc患者和30例年龄及性别匹配的非SSc个体纳入了这项前瞻性研究。通过使用24小时动态血压监测（ABPM）设备每30分钟测量一次血压来评估昼夜血压变化。无勺型模式定义为夜间血压较白天降低少于10%。为了更好地评估夜间血压波动，夜间测量被分为两个时间段：首先是24:00 - 04:00，然后是04:00 - 08:00。此外，还比较了两组之间的实验室和临床参数以及SSc亚型。比较了有和没有SSc的两组之间的ABPM结果。在所有时间间隔内，无勺型模式在SSc组中显著更常见。非SSc组中25.8%观察到无勺型模式，而SSc患者中为83.9%（<0.001）。在24:00至04:00期间，对照组患病率为25.8%，SSc患者为71.0%（<0.001）；在04:00至08:期间，对照组为35.5%，SSc患者为80.6%（<0.001）。弥漫性和局限性皮肤型系统性硬化症患者之间的无勺型模式无显著差异。SSc患者中无勺型血压模式显著更常见，表明影响血压的昼夜节律受到扰乱。将夜间分为特定时间段进行分析发现，这种恶化在整个夜间持续存在。这些发现突出了在SSc患者中进行昼夜血压监测的重要性，并可能有助于未来的风险分层和治疗策略。SSc中的昼夜血压分析可能有助于制定针对这些患者并根据其生理节律量身定制的策略。
