Background The 2017 ACC/AHA guidelines define hypertension as ≥130/80 mmHg instead of ≥140/90 mmHg. Studies in systemic autoimmune diseases, where blood pressure (BP) is fluctuating over time, were not considered. Our aim was to assess the impact of the new definition on the prevalence and incidence of atherosclerotic vascular events (AVEs) in systemic lupus erythematosus (SLE).

Patients-Methods SLE patients with at least two years of follow-up and no previous AVEs were divided in three groups (≥140/90 mmHg, 130–139/80–89 mmHg and <130/80 mmHg) according to the adjusted mean BP over that period. They were followed until the first occurrence of an AVE (new onset of: angina, myocardial infarction, congestive heart failure, revascularization procedure, transient ischemic attack, stroke and cardiovascular death) or last visit. Prevalence and incidence rates of AVEs were calculated. SAS 9.4 was used for statistics; p<0.05 was considered significant.

Results 1532 patients satisfied the inclusion criteria (88.1% females, mean age at baseline 36.2±14.3 years, mean disease duration 6.1±6.3 years). The prevalence of hypertension by the previous definition was 10.1% (155/1532) and with the current definition 30.7% (471/1532); the rest 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, there were 124 AVEs (104 non-fatal and 20 fatal). The total prevalence of AVEs was 32/155 (20.6%) in the ≥140/90 mmHg, 41/316 (13%) in the 130–139/80–89 mmHg and 51/1061 (4.8%) in the normotensive group, respectively. The cumulative incidence was 18.9, 11.5 and 4.5 per 1000 patient-years, respectively. Similar trends (gradually decreasing incidence rates for the ≥140/90 mmHg, 130–139/80–89 mmHg and <130/80 mmHg group) were found individually for the coronary artery disease (CAD) events, cerebrovascular events and cardiovascular deaths.

Conclusions SLE patients with an adjusted mean BP of 130–139/80–89 mmHg over two years developed approximately 2.5 fold more AVEs compared to the normotensives. The new definition of hypertension highlights a group of patients with a high incidence of AVEs who should be intensively targeted in order to improve cardiovascular outcomes.