Hypertension in autoimmune rheumatic diseases: a position paper from the European Society of Hypertension working group on small arteries. Part A: pathophysiology, prevalence and cardiovascular risk estimation

Abstract

Autoimmune rheumatic diseases (ARDs) are characterized by excessive immune system dysregulation and a significant inflammatory milieu that provokes multiorgan damage. Inflammation holds a key role in the pathophysiology of cardiovascular disease (CVD), thereby explaining the increased cardiovascular risk of patients with ARDs. Among all cardiovascular risk factors, hypertension is the most prevalent one in patients with ARDs. The pathogenesis of hypertension in ARDs is multifactorial and the result of a complex interplay between several traditional cardiovascular risk factors, the sympathetic nervous system, autoimmune disease specific factors and genetic predisposition. Importantly, even though patients with ARDs and hypertension suffer a markedly increased cardiovascular risk, current guidelines lack a widely accepted risk prediction tool to accurately estimate CVD risk and provide a highly individualized approach. This review aims to analyse the prevalence and pathophysiology of hypertension in patients with ARDs and provide an overview of cardiovascular risk assessment in this high-risk group.

Keywords: autoimmune rheumatic diseases; cardiovascular risk; endothelial dysfunction; inflammation.