Risk and predictors of arterial hypertension in patients with systemic scleroderma
Background. Patients with inflammatory joint diseases, which include systemic scleroderma (SS), have increased cardiovascular disease risk compared with the general population. Arterial hypertension (AH) is a major modifiable risk factor contributing to increased cardiovascular disease risk in inflammatory joint diseases. The purpose of the study was to investigate the prognosis and predictors of AH development in patients with SS. Materials and methods. We have conducted a 5-year prospective observation of 73 patients, who were in the regional registry. The investigation of risk for AH development was performed using the Kaplan-Meier procedure. Calculations of predictors’ influence on the risk of AH were performed using Cox regression. Results. The 5-year risk of AH development in SS was 20.3 %. Estimated risk of AH on the first, third and fifth year of the disease is 18.2, 25.0 and 19.4 %, respectively. The resulting impact of the initial clinical and laboratory parameters on the risk of AH development (hazard ratio): age > 45 years — 2.04, diffuse scleroderma — 0.65, Raynaud phenomenon — 1,17, tightness of the skin of the hands — 1.74, arthritis — 0.99, pulmonary fibrosis — 1.84, anemia — 0.78, erythrocyte sedimentation rate (ESR) > 25 mm/h — 1.68, C-reactive protein (CRP) level > 5 mg/l — 1.52, rheumatoid factor (RF) > 14 IU/ml — 1,48, proteinuria — 1.09. Conclusions. The 5-year risk of AH in SS is 20.3 %. The strongest influence on the risk of AH development in SS showed: age > 43.7 years, the presence of the tightness of the skin of the hands, pulmonary fibrosis, ESR > 25 mm/h, CRP > 5 mg/l, RF > 14 IU/mL. AH in systemic scleroderma has a heterogeneous nature. In patients, who had AH at the onset of SS, in a five-year term, we can expect an increase in the occurrence of proteinuria and glomerular filtration rate decline.
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