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  • Review Article
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Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases

Nature Reviews Cardiology volume 15, pages 33–44 (2018)Cite this article

Subjects

Key Points

  • Hypertension is highly prevalent in patients with systemic autoimmune and chronic inflammatory joint diseases

  • Immune-mediated mechanisms and chronic inflammation have been demonstrated to have a relevant role in the pathogenesis of hypertension

  • In systemic autoimmune and chronic inflammatory diseases, hypertension is a contributing factor to subclinical atherosclerosis and cardiovascular events

  • Patients with systemic autoimmune and chronic inflammatory diseases benefit from routine screening of hypertension given the evidence for underdiagnosis and undertreatment of elevated blood pressure in these patients

  • International evidence-based guidelines are needed for appropriate treatment of hypertension in patients with systemic autoimmune and chronic inflammatory diseases to reduce long-term, adverse cardiovascular outcomes

Abstract

Evidence for the increased risk of cardiovascular morbidity and mortality in patients with chronic inflammatory and systemic autoimmune diseases has accumulated during the past 15 years. In these patients, an interplay between several mechanisms, including premature acceleration of subclinical atherosclerotic damage, inflammation, and dysregulation of the immune system, is involved in the induction and progression of atherosclerosis. Moreover, traditional cardiovascular risk factors are also likely to contribute, at least in part, to the excess cardiovascular risk. Among traditional cardiovascular risk factors, hypertension is an important predictor of cardiovascular events in the general population and in patients with chronic inflammatory and autoimmune diseases. Evidence supports the idea that the pathogenic mechanisms underlying the increased blood pressure in these diseases are multifactorial and not only related to the mechanical injury of the arterial wall. In particular, chronic inflammation and immune-mediated mechanisms have been demonstrated to affect blood-pressure control in patients with systemic autoimmune disease. In this Review, we discuss the available evidence on the relationship between hypertension and autoimmune diseases, and describe the multiple factors that might affect blood-pressure control in patients with chronic inflammatory and systemic autoimmune diseases. We also discuss the effect of hypertension and antirheumatic therapies on cardiovascular outcome.

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Figure 1: Pathogenic mechanisms underlying hypertension in systemic autoimmune rheumatic diseases.

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  1. Department of Medicine, Rheumatology Unit, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy

    Elena Bartoloni, Alessia Alunno & Roberto Gerli

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E.B. researched data for the article, and wrote the manuscript. All the authors contributed substantially to the discussion of content, and reviewed/edited the manuscript before submission.

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Correspondence to Roberto Gerli.

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Bartoloni, E., Alunno, A. & Gerli, R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nat Rev Cardiol 15, 33–44 (2018). https://doi.org/10.1038/nrcardio.2017.118

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