Hypertension
Özet
Hypertension is a significant cardiovascular risk factor that is particularly relevant in patients with rheumatic diseases. This book chapter explores the complex relationship between hypertension and rheumatic diseases such as systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, antiphospholipid syndrome, and vasculitis. Chronic inflammation, endothelial dysfunction, renal and renovascular involvement, autonomic nervous system abnormalities, and medication side effects are key mechanisms contributing to hypertension in these patients. The role of inflammatory cytokines such as tumor necrosis factor-α and interleukin-6 in vascular dysfunction and hypertension is highlighted. Additionally, the impact of renal involvement, particularly in lupus nephritis and scleroderma renal crisis, is discussed.
Challenges in blood pressure measurement in rheumatic diseases due to vascular abnormalities and joint deformities are emphasized, with ambulatory blood pressure monitoring (ABPM) suggested as an effective tool. The chapter also reviews the pharmacological and non-pharmacological management strategies for hypertension in this population. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics are commonly used agents, while lifestyle modifications such as weight management, dietary sodium restriction, and smoking cessation play a critical role. Early detection and individualized management strategies are essential to mitigate cardiovascular risks in patients with rheumatic diseases.
Hipertansiyon, kardiyovasküler hastalıklar açısından önemli bir risk faktörü olup özellikle romatizmal hastalığı olan hastalar için büyük bir klinik öneme sahiptir. Bu kitap bölümünde, sistemik skleroz, romatoid artrit, sistemik lupus eritematozus, psöriatik artrit, ankilozan spondilit, antifosfolipid sendromu, ve vaskülit gibi hastalıklarda hipertansiyonun gelişim mekanizmaları ele alınmaktadır. Kronik inflamasyon, endotelyal disfonksiyon, böbrek ve vasküler tutulumları, otonom sinir sistemi anormallikleri ve ilaç yan etkileri, bu hastalarda hipertansiyona katkıda bulunan başlıca faktörlerdir. Tümör nekrosis faktör-α ve interlökin-6 gibi inflamatuar sitokinlerin damar fonksiyon bozukluğu ve hipertansiyon gelişimindeki rolü vurgulanmaktadır. Özellikle lupus nefriti ve skleroderma renal krizinde böbrek tutulumunun hipertansiyon gelişimine etkisi ele alınmaktadır.
Romatizmal hastalıklarda vasküler anomaliler ve eklem deformiteleri nedeniyle kan basıncı ölçümündeki zorluklar belirtilmekte ve ambulatuvar kan basıncı monitorizasyonunun (ABPM) etkin bir yöntem olduğu vurgulanmaktadır. Ayrıca, hipertansiyonun farmakolojik ve farmakolojik olmayan yönetim stratejileri gözden geçirilmektedir. Renal fonksiyon korunması açısından ACE inhibitörleri (ACEI) ve anjiyotensin reseptör blokerleri (ARB), kalsiyum kanal blokerleri ve diüretikler sık kullanılan ajanlardır. Bunun yanında, kilo kontrolü, diyetle sodyum alımının azaltılması ve sigara bırakma gibi yaşam tarzı değişikliklerinin önemli bir yeri vardır. Romatizmal hastalıklara sahip hastalarda hipertansiyonun erken teşhisi ve bireyselleştirilmiş tedavi yaklaşımları, kardiyovasküler riskleri azaltmak için hayati öneme sahiptir.
Referanslar
Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, et al. Hypertension. Nature reviews Disease primers. 2018;4:18014.
Bartoloni E, Alunno A, Gerli R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nature Reviews Cardiology. 2018;15(1):33-44.
Abass S, Fatima Q, Jeelani H, Ahmed A. Systemic autoimmune disorders. Role of Medicinal Plants in. 2025:85.
Castellon X, Bogdanova V. Chronic inflammatory diseases and endothelial dysfunction. Aging and disease. 2016;7(1):81.
Panoulas VF, Metsios GS, Pace A, John H, Treharne G, Banks M, et al. Hypertension in rheumatoid arthritis. Rheumatology. 2008;47(9):1286-98.
Taylor EB, Wolf VL, Dent E, Ryan MJ. Mechanisms of hypertension in autoimmune rheumatic diseases. British Journal of Pharmacology. 2019;176(12):1897-913.
Ahn S-H, Jung JH. Renal involvement in rheumatic diseases. Journal of Rheumatic Diseases. 2017;24(4):174-84.
Poulsen SB, Fenton RA. K+ and the renin–angiotensin–aldosterone system: New insights into their role in blood pressure control and hypertension treatment. The Journal of physiology. 2019;597(17):4451-64.
Paul S, Sangle S, Bennett A, El-Hachmi M, Hangartner R, Hughes G, et al. Vasculitis, antiphospholipid antibodies, and renal artery stenosis. Annals of the rheumatic diseases. 2005;64(12):1800-2.
Bellocchi C, Carandina A, Montinaro B, Targetti E, Furlan L, Rodrigues GD, et al. The interplay between autonomic nervous system and inflammation across systemic autoimmune diseases. International journal of molecular sciences. 2022;23(5):2449.
Rehman SU, Chopra VS, Dar MA, Maqbool M, Qadrie Z, Qadir A. Advancing rheumatic disease treatment: A journey towards better lives. Open Health. 2024;5(1):20230040.
Goodwin JE, Geller DS. Glucocorticoid-induced hypertension. Pediatric nephrology. 2012;27:1059-66.
Zheng L, Du X. Non-steroidal anti-inflammatory drugs and hypertension. Cell biochemistry and biophysics. 2014;69:209-11.
Klocke R, Cockcroft J, Taylor G, Hall I, Blake D. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Annals of the rheumatic diseases. 2003;62(5):414-8.
Chew E, Barnado A, Ikizler TA, Zent R, Frech T. Evaluation of hypertension in systemic sclerosis and systemic lupus erythematosus overlap. Journal of Scleroderma and Related Disorders. 2023;8(1):14-9.
Schmidt WA, Gromnica-Ihle E. What is the best approach to diagnosing large-vessel vasculitis? Best Practice & Research Clinical Rheumatology. 2005;19(2):223-42.
Shimbo D, Abdalla M, Falzon L, Townsend RR, Muntner P. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review. Ann Intern Med. 2015;163(9):691-700.
Asano Y. Systemic sclerosis. The Journal of dermatology. 2018;45(2):128-38.
Lambova S. Cardiac manifestations in systemic sclerosis. World journal of cardiology. 2014;6(9):993.
Bose N, Chiesa-Vottero A, Chatterjee S, editors. Scleroderma renal crisis. Seminars in arthritis and rheumatism; 2015: Elsevier.
Khan SL, Mathai SC. Scleroderma pulmonary arterial hypertension: the same as idiopathic pulmonary arterial hypertension? Current opinion in pulmonary medicine. 2023;29(5):380-90.
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: extra-articular manifestations and comorbidities. Autoimmunity reviews. 2021;20(4):102776.
Hadwen B, Stranges S, Barra L. Risk factors for hypertension in rheumatoid arthritis patients–A systematic review. Autoimmunity reviews. 2021;20(4):102786.
Bordy R, Totoson P, Prati C, Marie C, Wendling D, Demougeot C. Microvascular endothelial dysfunction in rheumatoid arthritis. Nature Reviews Rheumatology. 2018;14(7):404-20.
Meyer PW, Anderson R, Ker JA, Ally MT. Rheumatoid arthritis and risk of cardiovascular disease. Cardiovascular journal of Africa. 2018;29(5):317-21.
Oliveira CB, Kaplan MJ, editors. Cardiovascular disease risk and pathogenesis in systemic lupus erythematosus. Seminars in immunopathology; 2022: Springer.
Munguia-Realpozo P, Mendoza-Pinto C, Benito CS, Escarcega RO, Garcia-Carrasco M, Martinez SM, et al. Systemic lupus erythematosus and hypertension. Autoimmunity reviews. 2019;18(10):102371.
Shaharir SS, Mustafar R, Mohd R, Mohd Said MS, A. Gafor H. Persistent hypertension in lupus nephritis and the associated risk factors. Clinical rheumatology. 2015;34:93-7.
Moschetti L, Piantoni S, Vizzardi E, Sciatti E, Riccardi M, Franceschini F, et al. Endothelial dysfunction in systemic lupus erythematosus and systemic sclerosis: A common trigger for different microvascular diseases. Frontiers in Medicine. 2022;9:849086.
Ferguson LD, Siebert S, McInnes IB, Sattar N. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nature Reviews Rheumatology. 2019;15(8):461-74.
A Brezinski E, R Follansbee M, J Armstrong E, W Armstrong A. Endothelial dysfunction and the effects of TNF inhibitors on the endothelium in psoriasis and psoriatic arthritis: a systematic review. Current pharmaceutical design. 2014;20(4):513-28.
El Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. European journal of internal medicine. 2011;22(6):554-60.
Sari I, Okan T, Akar S, Cece H, Altay C, Secil M, et al. Impaired endothelial function in patients with ankylosing spondylitis. Rheumatology. 2006;45(3):283-6.
Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G. Cardiac manifestations of antiphospholipid syndrome with focus on its primary form. Frontiers in immunology. 2019;10:941.
Tektonidou MG. Renal involvement in the antiphospholipid syndrome (APS)—APS nephropathy. Clinical reviews in allergy & immunology. 2009;36:131-40.
Guillevin L, Dörner T. Vasculitis: mechanisms involved and clinical manifestations. Arthritis research & therapy. 2007;9:1-9.
Mittal T, Rathi M. Rheumatological diseases and kidneys: a nephrologist's perspective. International Journal of Rheumatic Diseases. 2014;17(8):834-44.
Stamatis P. Giant cell arteritis versus Takayasu arteritis: an update. Mediterranean Journal of Rheumatology. 2020;31(2):174-82.
Nurmohamed MT, Heslinga M, Kitas GD. Cardiovascular comorbidity in rheumatic diseases. Nature Reviews Rheumatology. 2015;11(12):693-704.
Turesson C, Jacobsson LT, Matteson EL. Cardiovascular co-morbidity in rheumatic diseases. Vascular health and risk management. 2008;4(3):605-14.
Rubattu S, Pagliaro B, Pierelli G, Santolamazza C, Di Castro S, Mennuni S, et al. Pathogenesis of target organ damage in hypertension: role of mitochondrial oxidative stress. International Journal of Molecular Sciences. 2014;16(1):823-39.
Hinchey JA, Sila CA. Cerebrovascular complications of rheumatic disease. Rheumatic disease clinics of North America. 1997;23(2):293-316.
Ritter J. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertension. BMJ. 2011;342.
Roush GC, Sica DA. Diuretics for hypertension: a review and update. American journal of hypertension. 2016;29(10):1130-7.
Tocci G, Battistoni A, Passerini J, Musumeci MB, Francia P, Ferrucci A, et al. Calcium channel blockers and hypertension. Journal of cardiovascular pharmacology and therapeutics. 2015;20(2):121-30.
Tomiyama H, Yamashina A. Beta‐Blockers in the management of hypertension and/or chronic kidney disease. International journal of hypertension. 2014;2014(1):919256.
Samuel PO, Edo GI, Emakpor OL, Oloni GO, Ezekiel GO, Essaghah AEA, et al. Lifestyle modifications for preventing and managing cardiovascular diseases. Sport Sciences for Health. 2024;20(1):23-36.
Gupta R, Guptha S. Strategies for initial management of hypertension. indian Journal of medical research. 2010;132(5):531-42.
He FJ, Tan M, Ma Y, MacGregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology. 2020;75(6):632-47.
Tsai S-Y, Huang W-H, Chan H-L, Hwang L-C. The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study. Tobacco induced diseases. 2021;19.
Anyfanti P, Gkaliagkousi E, Triantafyllou A, Koletsos N, Gavriilaki E, Galanopoulou V, et al. Hypertension in rheumatic diseases: prevalence, awareness, treatment, and control rates according to current hypertension guidelines. Journal of human hypertension. 2021;35(5):419-27.
