Nocturnal Blood Pressure Dipping As a Marker of Endothelial Function and Subclinical Atherosclerosis in Pediatric-onset Systemic Lupus Erythematosus

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Joyce C ChangAndrea M Knight

Abstract

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-hours) 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-di...Continue Reading

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