Specific features of hypertension in patients with systemic lupus erythematosus

Aim. To study the specific features of the development and course of hypertension in patients with systemic lupus erythematosus (SLE). Subjects and methods. A total of 106 age- and sex-matched patients, including 47 with SLE and 55 with hypertensive disease (HD), were examined. In all the patients, plasma renin levels were determined; serum von Willebrand factor antigen concentrations were estimated; desquamated endothelial cell counts were calculated; and 24-hour blood pressure (BP) monitoring (BPM) and Doppler ultrasound of carotid arteries performed. Results. In the patients with SLE and hypertension compared to those with HD, the mean diastolic BP (DBP) was 86.5 (79.5—93.5) mm Hg versus 80.5 (77—90) mm Hg (daytime) and 78 (69—91.5) mm Hg versus 72.5 (64—78) mm Hg (nighttime) (p<0.05), and there was also a decrease in daily DBP index (5 [0.5—15]% versus 11 [7.5—18]% (p<0.02)). The plasma renin levels were 1.67 (0.78—2.47) and 0.49 (0.25—0.81) ng/ml/h in the patients with SLE and in those with HD, respectively, р=0.04 and 0.42 (0.36—0.47) ng/ml/h in the control group (р=0.0001). An atherosclerotic vascular lesion was found in 52 and 32% of the patients with SLE and those with HD, respectively. The von Willebrand factor antigen levels were 1.63 (0.81—3.36) and 0.29 (0.23—2.8) IU/ml in these patients, respectively (p=0.04). The plasma circulating endothelial cell counts were also significantly higher in the patients with SLE and hypertension than in those with HD (8 [7—10]∙104/l and 5 [3—8]∙104/l (p<0.01). Conclusion. The patients with SLE and hypertension show a high rate of its hyper-renin states, a propensity for nocturnal hypertension, an increase in DBP, and obvious vascular endothelial regulatory dysfunction.