Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus

• Published in: Arthritis research & therapy Vol. 22; no. 1; pp. 1 - 129
• Main Authors: Chang, Joyce C, Xiao, Rui, Meyers, Kevin E, Mercer-Rosa, Laura, Natarajan, Shobha S, Weiss, Pamela F, Knight, Andrea M
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 03.06.2020; BioMed Central; BMC
• Subjects: Age; Ambulatory blood pressure monitoring; Arthritis; Atherosclerosis; Blood pressure; Blood pressure measurement; Cardiovascular diagnostic techniques; Cardiovascular disease; Carotid arteries; Creatinine; Development and progression; Endothelium; Ethnicity; Hypertension; Kidney diseases; Lupus; Medical diagnosis; Mortality; Pediatric systemic lupus erythematosus; Pediatrics; Population; Pressure measurement; Rheumatology; Risk factors; Standard deviation; Systemic lupus erythematosus; Veins & arteries
• ISSN: 1478-6362; 1478-6354; 1478-6362
• DOI: 10.1186/s13075-020-02224-w

Abstract Background Loss of the normal nocturnal decline in blood pressure (BP), known as non-dipping, is a potential measure of cardiovascular risk identified by ambulatory blood pressure monitoring (ABPM). We sought to determine whether non-dipping is a useful marker of abnormal vascular function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus (pSLE). Methods Twenty subjects 9–19 years of age with pSLE underwent ABPM, peripheral endothelial function testing, carotid-femoral pulse wave velocity/analysis for aortic stiffness, and carotid intima-media thickness. We assessed the prevalence of non-dipping and other ABPM abnormalities. Pearson or Spearman rank correlation tests were used to evaluate relationships between nocturnal BP dipping, BP load (% of abnormally elevated BPs over 24-h), and vascular outcome measures. Results The majority (75%) of subjects had inactive disease, with mean disease duration of 3.2 years (± 2.1). The prevalence of non-dipping was 50%, which occurred even in the absence of nocturnal or daytime hypertension. Reduced diastolic BP dipping was associated with poorer endothelial function ( r 0.5, p  = 0.04). Intima-media thickness was significantly greater in subjects with non-dipping (mean standard deviation score of 3.0 vs 1.6, p  = 0.02). In contrast, higher systolic and diastolic BP load were associated with increased aortic stiffness ( ρ 0.6, p  = 0.01 and ρ 0.7, p  < 0.01, respectively), but not with endothelial function or intima-media thickness. Conclusion In a pSLE cohort with low disease activity, isolated nocturnal BP non-dipping is prevalent and associated with endothelial dysfunction and atherosclerotic changes. In addition to hypertension assessment, ABPM has a promising role in risk stratification and understanding heterogeneous mechanisms of cardiovascular disease in pSLE.