Abstract
BackgroundLoss 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).MethodsTwenty 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.ResultsThe 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.ConclusionIn 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.
Highlights
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)
Of the two subjects with insufficient ABPM data, one did not wish to be seen wearing the monitor at school, while the other was intolerant of cuff inflations
Our findings suggest that attenuation of either systolic or diastolic BP dipping may be indicative of different pathologic cardiovascular states in pediatriconset systemic lupus erythematosus (pSLE)
Summary
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). Existing non-invasive measures of cardiovascular risk in the pediatric population, such as carotid intima-media thickness (cIMT), have demonstrated accelerated progression of subclinical atherosclerosis in pSLE [5]. Loss of the physiologic nocturnal BP decline, referred to as “nondipping”, is an independent predictor of target organ damage and cardiovascular mortality in both hypertensive and normotensive adults [6,7,8,9] This relationship is potentially mediated by endothelial dysfunction, one of the earliest stages of subclinical atherosclerosis (Fig. 1) [10]. There are no specific guidelines on the use of ABPM in pSLE
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