Abstract
Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort (n=10), 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.
Highlights
Ambulatory blood pressure monitoring (ABPM) is preferred to casual clinic blood pressure (BP) monitoring in the diagnosis of hypertension (HTN)
The revised manuscript takes into account the comments from the first three on-line reviews. It adds a requested comparison of the BP patterns between 2 sub-groups of lupus patients: non-renal pSLE patients vs. those with a history of lupus nephritis which were in remission at time of BP monitoring. It includes a brief literature review in the discussion on the effect of glucocorticoids on BP patterns, which might provide one possible explanation for the findings described in our pediatric lupus patient cohort
Whereas 60% had a history of lupus nephritis, none were currently being treated for active kidney disease
Summary
The revised manuscript takes into account the comments from the first three on-line reviews. It adds a requested comparison of the BP patterns between 2 sub-groups of lupus patients: non-renal pSLE patients vs those with a history of lupus nephritis which were in remission at time of BP monitoring. It includes a brief literature review in the discussion on the effect of glucocorticoids on BP patterns, which might provide one possible explanation for the findings described in our pediatric lupus patient cohort
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