Disturbances of circadian profile and blood pressure control in patients with systemic lupus erythematosus without overt heart disease

Introduction
Lupus erythematosus (SLE) is an autoimmune disease that causes a significantly increased risk of cardiovascular diseases. This process is underlain by the early and accelerated atherosclerosis. Aim: To assess the diurnal blood pressure profile disturbances in normotensive patients without overt cardiovascular disease and to correlate with early atherosclerotic markers.

Material and methods
The study included 32 baseline normotensive women with SLE and 30 healthy control women. Each participant underwent a 24-hour automatic blood pressure measurement and an ultrasound assessment of intima media thickness (IMT) and the presence of carotid atherosclerotic plaques.

Results
Atherosclerotic plaques were present in 46.9% of SLE women. They had a significantly higher IMT compared to those without atherosclerotic plaques and control group (0.833 ±0.216 vs. 0.606 ±0.121 vs. 0.66 ±0.16 mm). A significant positive correlation was found between IMT and age of patients, nocturnal systolic blood pressure (SBP), nocturnal systolic pressure (SP) load, nocturnal SBP decline and presence of atherosclerotic plaques. The plaques positively correlated with age and with ambulatory blood pressure monitoring (ABPM) parameters. Fifty percent of SLE women had an abnormal 24-hour BP profile, of which 4 had non-dipper, 8 invers, and 4 hyper-dipper profile. Based on ABPM, hypertension can be diagnosed in 14 (43.75%) initially normotensive women. Women with SLE and arterial hypertension (HA) had atherosclerotic plaques significantly more often, especially in nocturnal hypertension.

Conclusions
The authors confirm the underestimation of hypertension in SLE. Most women diagnosed with hypertension by ABPM had nocturnal hypertension. We showed a more frequent disturbed BP and a significant relationship between the abnormal BP profile, especially nocturnal hypertension, and accelerated development of atherosclerosis.