Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus
Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus
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DOI：
10.1186/s13075-020-02224-w
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发表时间：
2020-06-03
影响因子：
4.9
通讯作者：
Knight, Andrea M.
中科院分区：
文献类型：
--
作者：
Chang, Joyce C.;Xiao, Rui;Knight, Andrea M.
背景：失去正常的夜间血压下降（BP），被称为不下降，是动态血压监测（ABPM）确定的心血管风险的潜在指标。我们试图确定不浸渍是否是儿童发病系统性红斑狼疮（pSLE）血管功能异常和亚临床动脉粥样硬化的有用标志。方法20例9-19岁的pSLE患者行ABPM、外周内皮功能测试、颈动脉-股动脉脉波速度/主动脉硬度分析、颈动脉内膜-中膜厚度分析。我们评估了非倾斜和其他ABPM异常的患病率。使用Pearson或Spearman秩相关检验来评估夜间血压下降、血压负荷（24小时内血压异常升高的百分比）和血管结局测量之间的关系。结果大多数（75%）患者为非活动性疾病，平均病程3.2年（±2.1年）。不降血压的发生率为50%，即使在没有夜间或白天高血压的情况下也会发生。舒张压降低与内皮功能较差相关（r = 0.5, p = 0.04）。未倾斜受试者的内膜-中膜厚度显著增加（平均标准差评分3.0 vs 1.6, p = 0.02）。相比之下，较高的收缩压和舒张压负荷与主动脉硬度增加相关（分别为rho 0.6, p = 0.01和rho 0.7, p < 0.01），但与内皮功能或内膜-中膜厚度无关。结论：在低疾病活动度的pSLE队列中，孤立的夜间血压不降是普遍存在的，并与内皮功能障碍和动脉粥样硬化改变有关。除了高血压评估外，ABPM在pSLE的风险分层和了解心血管疾病的异质性机制方面也有很好的作用。
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 (rho 0.6, p = 0.01 and rho 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.