Antihypertensive effects of immunosuppressive therapy in autoimmune disease

J Hum Hypertens. 2023 Apr;37(4):300-306. doi: 10.1038/s41371-022-00682-0. Epub 2022 Apr 8.

Abstract

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder that primarily affects women of childbearing age. While immune system dysfunction has been implicated in the development of hypertension (HTN) in SLE, the effect of immunomodulatory drugs on blood pressure (BP) control in SLE patients is unknown. In the present study, we hypothesized that first-line immunomodulatory therapies prescribed to SLE patients would have a beneficial impact on BP. We retrospectively analyzed the Research Data Warehouse containing de-identified patient data (n = 1,075,406) from the University of Mississippi Medical Center for all patients with a clinical diagnosis of SLE. BP responses were analyzed in SLE patients that were initially prescribed a single therapy (methotrexate, hydroxychloroquine, azathioprine, mycophenolate mofetil (MMF), or prednisone). Of the 811 SLE patients who met criteria, most were hypertensive (56%), female (94%), and black (65%). Individuals prescribed MMF or hydroxychloroquine had significantly decreased BP and improved BP control at follow-up (>7 days and <3 months after initial visit). Our results suggest that MMF and hydroxychloroquine have beneficial effects on BP, independent of adjunctive antihypertensive therapies and existing renal disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Female
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Hypertension* / chemically induced
  • Hypertension* / diagnosis
  • Hypertension* / drug therapy
  • Immunosuppression Therapy
  • Immunosuppressive Agents / adverse effects
  • Lupus Erythematosus, Systemic* / diagnosis
  • Lupus Erythematosus, Systemic* / drug therapy
  • Mycophenolic Acid / therapeutic use
  • Retrospective Studies

Substances

  • Immunosuppressive Agents
  • Hydroxychloroquine
  • Antihypertensive Agents
  • Mycophenolic Acid