84 - Impact of Hypertension (HTN) on Health Related Quality of life in Childhood onset Systemic Lupus Erythematosus

Poster Number: 84
Publication Number: 84.324

Kristianna Singh, Texas Children's Hospital, Houston, TX, United States; Marietta DeGuzman, Baylor College of Medicine, Hosuton, TX, United States; Cortney Taylor Zimmerman, Baylor College of Medicine, Houston, TX, United States; Scott E. Wenderfer, Baylor College of Medicine, Houston, TX, United States; Alisa A. Acosta, Baylor College of Medicine, Houston, TX, United States

Background: SLE can significantly impact health-related quality of life (HRQOL) due to disease complications or necessary therapies. HTN also influences HRQOL. In cSLE, secondary HTN can be diagnosed in 30-70% due to nephritis and/or medications (i.e. steroids).

Objective: We assessed the impact of HTN on HRQOL in patients diagnosed with active SLE age 7-18 years at Texas Children Hospital.

Design/Methods: 11 subjects met inclusion criteria: (1) diagnosis of SLE, as determined by Rheumatology, (2) age 7-18 years, (3) new-onset disease or flare between 11/2020 and 05/2021. Subjects were excluded if unable to complete the questionnaire, had morbid obesity or CKD (comorbidities known to impact HRQOL). We classified HTN using ambulatory blood pressure monitoring (ABPM) at enrollment and office blood pressure at follow-up. HRQOL was measured by both patient and parent proxy, using the disease-specific SMILEY© (Simple Measure of Impact of Lupus in Youngsters) tool. Disease activity was scored by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Followup data were available for 9/11 patients 6-9 months after enrollment. Jamovi software was used to analyze demographic data with descriptive statistics. Fisher's exact and independent t-tests were used to assess differences between groups. Correlations between ABPM and SMILEY data were performed using Spearman rank.

Results: Median age at enrollment was 17 (IQR 13-18) years, and median SLEDAI was 11 (IQR 10-17). There were no differences in demographics or clinical features between normotensive and hypertensive groups at baseline. At baseline, SMILEY scores (child and parent) were 4 points lower in the hypertensive versus normotensive group. Mean 24-hr systolic (r=-0.7) and diastolic (r=-0.9) load, wake systolic (r=-0.7) and diastolic load (r=-0.7), and sleep diastolic load (r=-0.76) all correlated inversely with child SMILEY scores. At follow-up, those with baseline HTN had child SMILEY scores 8 points lower than the normotensive group. There were no differences in HRQOL between those who remained normotensive (n= 4) or had controlled HTN (n=2). Those with persistent HTN (pHTNf3) had an 8 and 7-point improvement in SMILEY score (child and parent). However, SLEDAI scores improved by 11 points in those with pHTN versus those who remained normotensive (5-point) or had controlled HTN (6-point).Conclusion(s): In cSLE, HTN significantly impacts HRQOL at the onset of disease, with lower child and parent-reported HRQOL. The impact of baseline HTN on child-reported scores persists through the initial 6-9 months of treatment regardless of their blood pressure control. 
Table 1 showing patient demographic and disease characteristics based on ABPM based classification of HTN at enrollment* use of t -test to assess for statistical differences. Abbreviations :MMF- mycophenolate mofetil, CYC-cyclophosphamide , AZA - azathioprine ,IVIG -Intravenous immunoglobulin
Table 2: Child and parent reported SMILEY scores based on ABPM based classification of HTN at enrollment* Denotes a significant decrease in HRQOL