Vascular events in hypertensive patients with systemic lupus erythematosus

Our purpose was to examine prospectively the relationship between systemic hypertension and vascular events in patients with SLE. SLE patients followed in the University of Toronto Lupus Clinic presenting between 1980 and 1988 and within one year of their diagnosis of SLE were id entified. Standard definitions were used for hypertension and for all vascu lar events (MI, angina, CVA, PVD). The presence of traditional CAD risk fac tors, along with disease- and therapy-related risk factors for the developm ent of vascular disease, were compared in the hypertensive and normotensive group. A multivariate logistic regression was performed to determine the b est predictor of a vascular event. One hundred and fifty patients were identified in our inception cohort [75 hypertensive (50%) and 75 (50%) normotensive]. Seventeen hypertensive patie nts (22.7%) had at least one vascular event as compared to six (8.0%) normo tensive patients (P = 0.022). The vascular events included 7 with CAD, 5 wi th CVA, and 5 with PVD in the hypertensive group while in the normotensive group 3 patients developed CAD, 2 CVA and 1 PVD. Fifteen deaths were record ed in the hypertensive group as compared to eight deaths in the non-hyperte nsive groups (P = 0.09). The groups were comparable with respect to associa ted risk factors, except for higher frequency of hypercholesterolemia (P = 0.003), azotemia (P = 0.001) and corticosteroid use (P = 0.038) in the hype rtension group. In a multivariate analysis the best predictor of a vascular event was hypercholesterolemia (OR 6.9, 95% CI 2.4-24.8, P < 0.001). We conclude that systemic hypertension is associated with an increased freq uency of vascular events in SLE. This is best explained by its association with hypercholesterolemia.