Article Text
Abstract
Objective Cardiovascular disease is one of the two leading causes of mortality in systemic lupus erythematosus (SLE). Hypertension, a traditional cardiovascular risk factor, is highly prevalent in SLE. Primary aldosteronism (PA), the most common endocrine cause of hypertension, remains under-screened and under-diagnosed, despite targeted treatment and surgical cure for PA being associated with a greater reduction in cardiovascular risk compared to blood pressure matched-essential hypertension. One study reported an association between PA and new onset of autoimmune diseases including SLE. However, whether PA contributes to hypertension in SLE has never been investigated. We aimed to determine the proportion of SLE patients with hypertension 1- meeting screening criteria for PA, 2- screened with an aldosterone-renin ratio (ARR), and 3- diagnosed with PA. We aimed to assess whether patients qualifying for PA screening had differences in SLE disease outcomes compared to those who did not.
Methods SLE patients attending the Monash Health lupus clinic between 2013–2022 were included in this retrospective study. Disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000) and organ damage (Systemic Lupus International Collaborative Clinics Damage Index) were assessed. Hypertension was defined as blood pressure ≥140 and/or ≥90 on 2+ clinical visits, or a documented diagnosis. Assessment for meeting PA screening criteria was conducted according to the Endocrine Society’s 2016 guidelines.
Results 322 patients were analysed (median age 41 years, 87% female; median disease duration and follow-up period: 6 years for both). Of those, 55% (178/322) had hypertension, and 8.7% (28/322) had drug-resistant hypertension. Of the hypertensive patients, 42.1% (75/178) were not recorded as such in medical records. 30% (95/322) met at least one criterion for PA screening; of those, 11% (10/95) were screened, including one abnormal result, and five suspicious results due to interfering medications. Patients qualifying for PA screening had higher renal disease activity and higher prevalence of cardiovascular and renal organ damage.
Conclusions Hypertension was highly prevalent, including 8.7% with resistant hypertension. Despite nearly a third qualifying for PA screening, only 11% were screened. Further research is needed to assess the prevalence of PA in SLE and its associations with disease outcomes.
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