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As the disease progresses, patients with lupus nephritis (LN) can develop end-stage renal disease and even die.
Existing studies have confirmed that concomitant hypertension is an independent risk factor for serious adverse outcomes in patients with LN.
So, in order to reduce the risk, how much should the blood pressure of LN patients be controlled? Scholars from the First Affiliated Hospital of Sun Yat-Sen University carried out a retrospective cohort study to explore the relationship between adverse outcomes (death, end-stage renal disease, doubling of creatinine) and systolic/diastolic blood pressure/mean arterial pressure in a subgroup analysis It provides a reference for blood pressure control of LN patients.
The results were recently published online in the journal J Hum Hypertens.
(IF: 2.
26).
Study Introduction The study included patients with LN (n=1406) who were admitted to the First Affiliated Hospital of Sun Yat-sen University between 1996 and 2011, aged ≥14 years, and confirmed by biopsy.
The patient's systolic/diastolic blood pressure/mean arterial pressure was recorded, and the restricted cubic spline (RCS) model was used to analyze the optimal level of blood pressure control.
The results of the study systolic blood pressure <126mmHg analysis data found that the systolic blood pressure and LN patients death, end-stage renal disease and creatinine doubling risk is a non-linear relationship, when the systolic blood pressure is about 115mmHg, the risk of death is the lowest.
Comprehensive analysis of the three endpoints, the investigator suggested that the systolic blood pressure of LN patients should be <126mmHg.
Figure 1 The correlation between systolic blood pressure and adverse outcomes in patients with LN.
Diastolic blood pressure 77~83mmHg analysis shows that the diastolic blood pressure of LN patients has a non-linear relationship with the risk of death, end-stage renal disease and creatinine doubling.
When the diastolic blood pressure is about 80mmHg, three All end points had the lowest risk (Figure 2).
Research suggests that the diastolic blood pressure of LN patients should be as close as possible to 77~83mmHg.
Figure 2 Correlation between diastolic blood pressure and adverse outcomes in LN patients The average arterial pressure 87~108mmHg As shown in Figure 3, the average arterial pressure of LN patients has a non-linear relationship with the risk of death.
When the average arterial pressure is 87mmHg, the risk of death is the lowest.
When the mean arterial pressure is 85~108mmHg, the risk of end-stage renal disease and creatinine doubling is relatively stable.
After the mean arterial pressure>108mmHg, the risk increases significantly.
Therefore, it is recommended to maintain the mean arterial pressure at 87~108mmHg.
Figure 3 The correlation between mean arterial pressure and adverse outcomes in LN patients.
Conclusions Hypertension increases the risk of death, end-stage renal disease and doubling of creatinine in LN patients.
Therefore, clinical blood pressure management should be paid attention to in LN patients.
Studies have shown that systolic blood pressure <126mmHg, diastolic blood pressure 77~83mmHg, and keeping the mean arterial pressure at 87~108mmHg can reduce the risk of adverse outcomes in patients with LN.
It is hoped that this can provide a reference for the blood pressure management of LN patients in the clinic.
The 2021 version of the Clinical Practice Guidelines for Blood Pressure Management in Chronic Kidney Disease (CKD) issued by the Global Kidney Disease Prognosis Organization (KDIGO) recommends that for patients with hypertension and chronic kidney disease, renin-angiotensin system inhibitors are the first choice for initial blood pressure reduction.
In addition to drug treatment, KDIGO also recommends that patients with chronic kidney disease reduce salt intake and increase physical exercise.
Recommended reading: KDIGO updates blood pressure management guidelines for chronic kidney disease References: Rong R, Wen Q, Wang Y, et al.
Prognostic significance of hypertension at the onset of lupus nephritis in Chinese patients: prevalence and clinical outcomes[J].
J Hum Hypertens.
2021 Mar 8.
doi: 10.
1038/s41371-021-00492-w.
Epub ahead of print.
Existing studies have confirmed that concomitant hypertension is an independent risk factor for serious adverse outcomes in patients with LN.
So, in order to reduce the risk, how much should the blood pressure of LN patients be controlled? Scholars from the First Affiliated Hospital of Sun Yat-Sen University carried out a retrospective cohort study to explore the relationship between adverse outcomes (death, end-stage renal disease, doubling of creatinine) and systolic/diastolic blood pressure/mean arterial pressure in a subgroup analysis It provides a reference for blood pressure control of LN patients.
The results were recently published online in the journal J Hum Hypertens.
(IF: 2.
26).
Study Introduction The study included patients with LN (n=1406) who were admitted to the First Affiliated Hospital of Sun Yat-sen University between 1996 and 2011, aged ≥14 years, and confirmed by biopsy.
The patient's systolic/diastolic blood pressure/mean arterial pressure was recorded, and the restricted cubic spline (RCS) model was used to analyze the optimal level of blood pressure control.
The results of the study systolic blood pressure <126mmHg analysis data found that the systolic blood pressure and LN patients death, end-stage renal disease and creatinine doubling risk is a non-linear relationship, when the systolic blood pressure is about 115mmHg, the risk of death is the lowest.
Comprehensive analysis of the three endpoints, the investigator suggested that the systolic blood pressure of LN patients should be <126mmHg.
Figure 1 The correlation between systolic blood pressure and adverse outcomes in patients with LN.
Diastolic blood pressure 77~83mmHg analysis shows that the diastolic blood pressure of LN patients has a non-linear relationship with the risk of death, end-stage renal disease and creatinine doubling.
When the diastolic blood pressure is about 80mmHg, three All end points had the lowest risk (Figure 2).
Research suggests that the diastolic blood pressure of LN patients should be as close as possible to 77~83mmHg.
Figure 2 Correlation between diastolic blood pressure and adverse outcomes in LN patients The average arterial pressure 87~108mmHg As shown in Figure 3, the average arterial pressure of LN patients has a non-linear relationship with the risk of death.
When the average arterial pressure is 87mmHg, the risk of death is the lowest.
When the mean arterial pressure is 85~108mmHg, the risk of end-stage renal disease and creatinine doubling is relatively stable.
After the mean arterial pressure>108mmHg, the risk increases significantly.
Therefore, it is recommended to maintain the mean arterial pressure at 87~108mmHg.
Figure 3 The correlation between mean arterial pressure and adverse outcomes in LN patients.
Conclusions Hypertension increases the risk of death, end-stage renal disease and doubling of creatinine in LN patients.
Therefore, clinical blood pressure management should be paid attention to in LN patients.
Studies have shown that systolic blood pressure <126mmHg, diastolic blood pressure 77~83mmHg, and keeping the mean arterial pressure at 87~108mmHg can reduce the risk of adverse outcomes in patients with LN.
It is hoped that this can provide a reference for the blood pressure management of LN patients in the clinic.
The 2021 version of the Clinical Practice Guidelines for Blood Pressure Management in Chronic Kidney Disease (CKD) issued by the Global Kidney Disease Prognosis Organization (KDIGO) recommends that for patients with hypertension and chronic kidney disease, renin-angiotensin system inhibitors are the first choice for initial blood pressure reduction.
In addition to drug treatment, KDIGO also recommends that patients with chronic kidney disease reduce salt intake and increase physical exercise.
Recommended reading: KDIGO updates blood pressure management guidelines for chronic kidney disease References: Rong R, Wen Q, Wang Y, et al.
Prognostic significance of hypertension at the onset of lupus nephritis in Chinese patients: prevalence and clinical outcomes[J].
J Hum Hypertens.
2021 Mar 8.
doi: 10.
1038/s41371-021-00492-w.
Epub ahead of print.
