(033) Risk of hypertension and type 2 diabetes in patients with systemic lupus erythematous: A retrospective cohort study in Yinzhou, China

Background: Hypertension (HTN) and type 2 diabetes mellitus (T2DM) in systemic lupus erythematosus (SLE) patients can lead to increased risks of cardiovascular diseases, renal dysfunction and death. The risks of HTN and T2DM in Chinese SLE patients remain unclear.

Objectives: To determine the risks of developing HTN and T2DM in newly diagnosed patients with SLE in the Yinzhou District of Ningbo, China, and to identify the influencing factors.

Methods:

Design: Retrospective cohort study.
Setting: This study was conducted using data from YRHIP between January 1, 2010 and October 31, 2021. The cohort consisted of a group of SLE patients and a group of matched non-SLE patients. Patients with malignant tumors and other autoimmune diseases, and SLE patients with diagnosis of HTN or T2DM at baseline were excluded. Patients with a record of SLE diagnosis 1 year prior to study period were excluded.
Exposures: Newly diagnosed SLE.
Main outcome measures: Newly diagnosed HTN and T2DM.
Statistical analysis: The relative risks of HTN and T2DM in SLE patients were analyzed using Cox regression models. In subgroup analysis, we grouped participants according to gender, age ( < 45 and ≥45 years old) and education level. In patients with SLE, the effect of hydroxychloroquine, glucocorticoids, immunosuppressants and disease severity of SLE on the risk of outcomes were examined.

Results: 349 and 466 SLE patients, 1396 and 1864 matched non-SLE patients were enrolled in the HTN and T2DM cohorts, respectively. We found that SLE patients had a significantly higher risk of HTN than non-SLE patients (HR=3.40, 95% CI: 2.51-4.61). The risk of T2DM was found not to be significantly different between SLE and non-SLE (HR=1.29, 95% CI: 0.76-2.20). The risk of HTN was found to be 5.10 times higher in men with SLE (HR=6.10, 95% CI: 2.73-13.59) and 2.27 times higher in women with SLE (HR=3.27, 95% CI: 2.32-4.61). In SLE patients < 45 years, the risks of HTN (HR=5.89, 95% CI: 3.97-8.75), and T2DM (HR=2.74, 95% CI: 1.28-5.89) were increased. The risk of HTN was lower in SLE patients with cumulative doses of hydroxychloroquine >40,000 mg compared with patients who had not used hydroxychloroquine (HR=0.23, 95% CI: 0.10-0.53). Patients with either moderate or severe disease severity had a higher risk of developing HTN compared with patients with lower disease severity. However, the present study did not find any association between T2DM risk and the use of three medications, or the severity of disease in SLE patients.

Conclusions: SLE is an independent risk factor for the development of HTN. Patients with more severe SLE are at a higher risk of developing HTN. The use of hydroxychloroquine may potentially reduce HTN risk in SLE patients. SLE patients had no increased T2DM risk, while younger SLE patients have a higher risk of developing T2DM.