O. Abrahamovych1, U. Abrahamovych1, A. Kushyna1, S. Guta1, O. Synenkyi2
1Danylo Halytsky Lviv National Medical University
2Lviv Regional Clinical Hospital
Introduction. The course of the systemic lupus erythematosus, as it is known, is often accompanied by syntopeal cardiovascular system lesion [1, 2]. Comapred to the general population in SLE patients, the risk of their occurrence increases by 4.0-76.0 %, especially among young and middle-aged people [3]. As causes in the first position in the structure of fatal consequences, they are in the structure of mortality of of these patients [4-6]. Prominent among them is arterial hypertension (AH) [7], the prevelance of which in SLE patents significantly exceed the general prevalence amno adult population of Ukraine [4]. It is AH as an important factor in the risk of developing and increasing the syntopeal cardiovascular severity complications in SLE patients. It is sometimes worsening the quality of life and often becomes the main cause of death. In this point of view, the feature identification of the arterial pressure (AP) in SLE patients, in particular, depending on clinically relevant indicators. Among them and the pathological process activity it is an important and topical issue that requires research.
The aim of the research is to determine the dependence of the indicators of daily blood pressure monitoring (DMAT) on the activity of the pathological process in SLE patients during the course of the day. AH in SLE patients with microwave radiation during the passive and active periods.
Research materials and methods. In Danylo Halytsky Lviv National Medical University Rheumatologic centre of the Lviv Regional Clinical Hospital 83 patients were examined in randomized manner [71 women (85.5 %) and 12 men (14.5 %) 17-68 year-olds (average age during the DMAT survey is 38.6 ± 1.3 years old)], who are diagnosed SLE according to the Americal Rheumathologist Collegium (1982, 1997). Sooner, these patients were stratified into three groups by the DMAT pathological process activity. The 1st group (with I-degree activity) was included 30 patients [25 women (83.3 %) and 5 men (16.7 %)] 22-66 year-olds (average age during the survey was 42.9 ± 2.1).
The 2nd group (with II-degree) was included 39 patients [33 women (84.6 %) and 6 men (15.4 %)] 17-68 year-olds (average age was 37.9 ± 1.8). The control group (with III-degree) was included with 35 particularly healthy people, which were corresponded to the three groups’ patients according to gender and age indicators.
DMAT was taken part via ABPM-04 apparatus (Meditech company, Hungary), which was standardizedfor two international accurancy classes – Association for Advancement of Medicals Instrumentation (AAMI) (США) and British Hypertension Society (BHS) (Great Britain). According to standart protocol, monitor was activated every 15 minutes in day time (from 6 a.m. to 9.59 p.m.) and every 30 minutes in night time (from 10 p.m. to 5.59 a.m.).
Table 1
Indicators of Daily Blood Pressure Monitoring in the Control Group
SLE activity was compared with II and III-degree patients, and also II-degree patients were compared with III-degree patients, finding out If AH indicators are changing or not due to SLE increasing activity and If so, then how.
Actual material was worked out on personal computer in Microsoft Excel, using description sttistics and Stewdent’s t-criteria for sample comparison with normal distribution. Obtained results were presented in М ± м, n – a count of inspected patients in the group.
According to Helsinki Declaration of Human Rights, Council of European Convention on Human Rights and Biomedicine and relevant lows of Ukraine, all measures about human health, patient rights, human dignity and ethical norms were taken.
Research results and their discussion. The results of the first task are presented in tables 2-4. The first step of the task is dedicated to daily average, maximal and minimal research of SysAH, DiaAH and MAH level during the day and night in SLE patients depending on the disease activity (table 2).
Table 2
Daily Average, Maximal and Minimal Stylistics, Diastolic and Average Arterial Hypertension Levels During the Day and Night for SLE Patients Depending on the Activity of the Disease (n; M ± m; p) 
Notes: * – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ** – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 2nd groups; *** – р < 0.001 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ### – р < 0.001 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ∆ – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 3rd groups; ∆∆ – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 3rd groups; ∆∆∆ – р < 0.001 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
According to the first task, AH indicators were assessed in SLE patients during the day and night: daily average, maximal and minimal systological AH (SysAH), diastolic AH (DiaAH), middle AH (MAH) were investigated; Daily index (DI) of the SysAH, DiaAH, MAH were analyzed; Time Index (TI) of the SysAH, DiaAH, MAH were studied.
According to the second task, AH indicators in SLE patients were assessed during the active and passive periods; daily average, maximal and minimal levels of SysAH, DiaAH, MAH were investigated during the active period; also, daily average, maximal and minimal levels of SysAH, DiaAH, MAH were assessed during the passive period; TI SysAH, DiaAH, MAH were studied during the passive and active period.
DMAT indicators in I-degree SLE patients were compared with others active degrees.
The obtained results indicate that the I-degree patients are only maximal SysAH, DiaAH and MAH exceeded the reference values in Control group patients, when the II- and III-degree group patients all daily average, maximal and minimal SysAH, DiaAH, MAH levels during the day and night were higher then in the healthy patients.
Particularly all (except DiaAH) daily average, maximal and minimal AH levels of DMAT are getting higher with SLE increasing, but not all with statistical probability. Thus, SysAH daily average level patients in researched group reliably is getting higher with directly proportional to the SLE increasing of the degree: 6.2 ± 3.1 % (р < 0.05) in the second group in comaparison with the first one, 10.5 ± 3.6 % (р < 0.01) – in the third group in comparison with the second one, 17.3 ± 3.5 % (р < 0.001) – in the third group in comparison with the first one. Maximal SysAH reliably rises in III-degree patient’s activity in cmparison with the patients from the I-degree group on 11.9 ± 6.2 % (р < 0.01).
Minimal SysAH reliably lower then in patients from I- and II-degree group activity in comparison with the III-degree group on 16.5 ± 4.1 % (р < 0.001) and 12.1 ± 4.2 % (р < 0.01). Daily average DiaAH level also reliably lower then the I- and II-degree group in patients then the ones in III-degree group: 14.4 ± 2.6 % (р < 0.001) and 10.1 ± 2.6 % (р < 0.05). Indicators of the maximal DiaAH level of probable changes, which depend on SLE activity degree do not demonstrate, As well as daily average, maximal, minimal DiaAH level reliably lower in I- and II-degree group of patients in comparison with patients from the III-degree group for 20.6 ± 2.8 % (р < 0.001) і 14.2 ± 2.8 % (р < 0.05).
Daily average and minimal MAH levels, as well as previous ones, reliably lower with I- and II-degree levels in comparison with the III-degree: 15.7 ± 2.7 % (р < 0.001), 10.2 ± 2.7 % (р < 0.01) and 18.9 ± 3.1 % (р < 0.001), 12.5 ± 3.1 % (р < 0.01).
Maximal MAH level is also a little increasing with SLE growth degree activity, but unreliably. Comparing AH indicators in SLE patients during the day and night, we can state that AH are increasing with SLE growth degree activity by all indicators (except DiaAH maximal). The most appropriate is the pattern of concistent dependence on the increase in the severity of the disease demonstrated the result of those evaluations of daily average SysyAH, minimal SysAH, daily average DiaAH, minimal DiaAH, daily average MAH and minimal MAH.
Of all indicators that characterized an increase in blood preassure in patients of II-degree activity in comparison with SLE patients from I-degree, SysAH daily average indicators are reliable.
The most convicing information, that increasing the SLE activity, was found in III-degree group of patients, that was compared with 7 out of 9 SysAH, DiaAH and MAH indicators (except maximal DiaAH and MAH, which results are not credible) with the second (except SysAh maximal, which level a little deferentiate, but does not crediate) and the first groups of patients.
The second step of the first task is devoted to the weighty indicator study, which indicates a violation of the daily AH rhythm due to its insufficient reduction in the night period, DI systolic, diastolic and mean AH during the day and night in SLE patients, which depends on disease activity (table 3).
Table 3
Daily Index of Systolic, Diastolic and Average Arterial Hypertension Levels During the Day and Night in SLE Patients Depending on the Activity of the Disease (n; M ± m; p) 
Notes: * – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ** – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ∆ – р <0.05 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
As we can see from the table 3, DI indicators in patients from all three groups are lower the reference values in health people. These indicators analysis, depending on SLE activity, shows that DI SysAH and DiaAH and MAH in II-degree group of patients’ activities are reliably lower then in I-degree group of patients’ activity – DI SysAH lower for 53.2 ± 1.9 % (р < 0.01), DI DiaAH – for 30.8 ± 2.0 % (р < 0.05), DI MAH – for 39.8 ± 1.8 % (р < 0.01), so, with SLE activity increasing, AH night decreasing are getting lower in these patients. Instead, during the DI comparison of mentioned AH indicators between patients from II- and III-degree group activity, the normality was not seen. III-degree activity patients’ DI indicators were higher then SLE patients with II-degreee of activity (DI SysAH – 15.5 ± 1.8 % higher, DI DiaAH – 26.4 ± 2.6 % higher, and DI MAH – 24.6 ± 2.2 % higher). However, it is unreliable that it may be due to an insufficient number of people surveyed in the experimental group to testify to the inclusion of compensatory mechanisms in the patient’s body with the highest SLE activity.
The results of DI SysAH, DiaAH and MAH in III-degree SLE activity in patients were compared with the I-degree group results. It showed that with increasing of pathological process growth, all DI indicators are getting lower [DI SysAH 45.9 ± 2.1%, DI DiaAH – 12.5 ± 2.6 %, and DI MAH – 25.5 ± 2.2 %], however, reliably (р < 0.05) is only SysAH.
As DI is a valuable indicator, which shows violation of daily AH rhythm via its insufficient decreasing in night time. So, the results show that with SLE increasing the severity of the circadian AH rhythm of change with a decrease in the number of preserved pdysiological rhythm patients. An increase in AH deficit reduction in the passive period and an increase in the number of sick pight-peakers with the pon-dipper phenomenon. This may indicate a malignant course of hyperetension, the presence of its symptomatic variables and it is considered to be independent of the risk of death of the cardiovascular complications.
To find out the frequency of hypertension episodes, SysAH, DiaAH and MAH, TI indicators, which shows the number of simultaneous, in which AH exceeded the permissible norm were assessed. Comparing its indicates between SLE patients with different degreesof action (the third step of the first task).
The study results are shown in Table 4.
Table 4
Time index of systolic, diastolic and average arterial hypertension levels during the day and night in SLE patients depending on the activity of the disease (n; M ± m; p)
Notes: * – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ** – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 2nd groups; # – р < 0.05 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ## – р < 0.01 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ∆∆∆ – р <0.001 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
As we can see in Table 4, all TI indicators are higher the reference values and with SLE activity increasing reliably growth; only TI DiaAH, in comparison with I- and II-group without statistical probability.
So, TI in II-degree group of SLE activity patients. Except TI DiaAH, is higher [СисАТ 90.4 ± 5.4 % (р < 0.01), TI DiaAH – 42.8 ± 5.0 %, and TI MAH – 74.3 ± 4.9 % (р <0.05)] in comparison with indicators from I-degree group of SLE activity. Similar TI indicators of changes can be seen in I-degree group [TI SysAH reliably lower for 72.1 ± 7.5 % (р < 0.001), TI DiaAH – for 61.6 ± 7.7 % (р < 0.001), and TI MAH – for 72.2 ± 7.9 % (р < 0.001)] and ІІ [TI SysAH reliably lower for 82.3 ± 8.2 % (р < 0.01), TI DiaAH – for 83.7 ± 7.9 % (р < 0.05), and TI MAH – for 106.1 ± 8.3 % (р < 0.01)] of activity degree was compared with SLE activity III-activity group.
Obtained results of the TI research revealed about SLE complication. The frequency of the episodes is growing, in which AH exceeded the permissible standarts.
Consequently, comparing the AT indicators during the day, SLE patients have a high risk, the presence of a significant increase in bold pressure with an increase of the ICSC validity degree in almost all of them (except for the maximul with changes in the physiological circadian thythm fir its developments). Insufficient increase in the episode frequency, in which the blood pressure exceeded the permissible norms. Results of ICSC evaluation in SLE patients during the active and passive perios (the second task) are shown in tables 5-7.
Table 5
Daily Average, Maximal and Minimal Daily Systolic, Diastolic and Average Arterial Hypertension Levels During the Day and Night for SLE Patients Depending on the Activity of the Disease (n; M ± m; p)
Notes: ## – р < 0.01 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ∆∆ – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 3rd groups; ∆∆∆ – р < 0.001 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
After the information analyzing in table 5 (the first step of the second task), we can confirm that all indicators in three groups of patients exceed referent values, except daiy average MAH in I-degree group and minimum MAH in II-degree group. And all nine indicators, which characterized AH during active period, are researched in I-, II- ad III-degree activity groups, are naturally increasing with SLE activity degrees accuring (except maximum DiaAH in third group).
However, the comparison of these indicators in I- and SLE activity of II-degrees patients’ naturally shows indicators increasing during active period with SLE activity degree growth without credible differences between groups.
Comparing daily average, maximum and minimum SysAH, DiaAH and MAH in SLE patients with II- and III-degree of activity, we revealed the 8 out of 9 indicators (excepr DiaAH maximum) with SLE activity increasing are growing and all except MAH maximum with statisticly proved credibility [daily average DiaAH increased in 11.0 ± 3.5 % (р < 0.01), maximum SysAH in 7.2 ± 6.1 % and SysAH minimum in 15.14 ± 4.10 % (р < 0.01); daily average DiaAH in 11.1 ± 2.9 % (р < 0.01), maximum DiaAH got lower in 1,7 ± 4,8 %, minimum DiaAH got higher in 18.31 ± 6.20 % (р < 0.01); daily average MAH was higher in 11.2 ± 2.8 % (р < 0.01), maximum MAH in 7.2 ± 6.1 %, minimum MAH in 15.8 ± 3.4 % (р < 0.01)].
So, in SLE activity patients with III-degree all levels (minimum and maximum SysAH, DiaAH and MAH were credibly increased in comparison with SLE activity patients from II-degree group. Maximal SysAH, DiaAH and MAH indicators in patients from III-degree activity group do not have any credible differences from the same indicators in SLE patirnts from II-degree activity group.
The metioned indicators research between SLE patients from I- and II-degree activity groups showed that in III-degree activity patients were compared with I-degree group. All studied indicators were credibly increased, except maximum DiaAH and maximum MAH [daily average SysAH was higher on 15.8 ± 3.4 % (р < 0.01)], maximum SysAH in 11.47 ± 6.40 % (р < 0.01), minimum SysAH in 17.28 ± 3.65 % (р < 0.001); daily average DiaAH was higher in 13.78 ± 2.80 % (р < 0.001), maximum DiaAH in 6.0 ± 4.8 %, minimum DiaAH in 21.29 ± 2.90 % (р < 0.001); daily average MAH was higher in 14.71 ± 2.80 % (р <0.001), maximum MAH – 7.68 ± 5.30 %, minimum MAH – 18.93 ± 3.20 % (р < 0.001)].
Information analysis in table 5 confirm us that all nine indicators, which characterized AH during active period, are researched in I-, II- and III-degree activity groups in SLE patients, naturally, are increasing (except maximum DiaAH in third group) with SLE activity degree increasing; directly proportial dependence between an increase in the severity of the disease and the value of the studied indicators are the most clear in third group patients in comparison with the third and especially with the first group of patients.
Table 6
Time Index of Systolic, Diastolic and Average Arterial Hypertension Levels During the Passive Period for SLE Patients Depending on the Activity of the Disease (n; M ± m; p)
Notes: * – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ** – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 2nd groups; # – р < 0.05 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ## – р < 0.01 is a Stewdent t-criteria, comparison between 2nd and 3rd groups; ∆∆ – р <0.01 is a Stewdent t-criteria, comparison between 1st and 3rd groups; ∆∆∆ – р <0.001 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
As we can see it in table 6 (the decond step of the second task), of the 9 indicators in patients with three groups (27 indicators in total), the ICSC results were significantly lower than the active period (3 out of 27), which was lower than the reference (9 out of 27), and this was related to the average daily SystAH in patients with the first group, the maximum SysAH patients with the first and second group, the average daily DiaAAH in the patients of the first and second groups, DiaAH maximal in patients of all three groups and minimal SAT in patients of the first group.
All nine indicators that characterize the blood pressure during the passive period, have been studied in patients with I, II and III degrees of activity, naturally increase with the increase in the SLE activity degree.
Analyzing the indicators in patients with the second group, compared to the first one, we can state that all nine indicators that characterize the blood pressure during the passive period, have been studied in patients with I and II activity levels, increase with the SLE activity degree’s groeth, but among them only five out of nine – with a definite difference [the average daily SysAH was higher in patients with the second stage of activity of the SLE for 9.84 ± 3.50 % (p < 0.01), the maximum SysAT – by 9.1 ± 4.5% (p < 0.01), the minimum CisAT – by 10.16 ± 3.30 % (p < 0.01); the average daily MAH was higher at 8.21 ± 2.9% (p <0.05) and the minimum SAT – at 9.67 ± 2.70 % (p < 0.05)].
Filed in tabl. 6 results of the ICSC concerning the comparative analysis of all nine indicators that characterize the blood pressure during the passive period in patients with II- and III-degrees of SLE activity allow to state that all of them also have signs of increase with the SLE degree of activity growth, but among them only three from nine – with a definite difference [the average daily SysAH was higher at 9.97 ± 4.30 % (p < 0.01), the maximum SysAH – by 9.98 ± 5.50 % (p < 0.05) and the average daily MAH – at 8.9 ± 3.1% (p < 0.05)].
It should be emphasized that the maximum number of reliable results of increasing the SysAH, DiaAH and MAH in the passive period (eight out of nine indicators) was found when comparing patients with III activity levels and I. Thus, the average daily SysAH was higher by 20.78 ± 4.40 % (p < 0.001), the maximum SysAH was 19.93 ± 5.10 % (p < 0.001), the minimal SysAH was 17.34 ± 4.40 % (p < 0.001); the average daily DiaAH was higher by 16.37 ± 2.80 % (p < 0.001), the maximum DiaAH was 9.3 ± 4.0% and the minimum DiaAH was 17.69 ± 2.90 % (p < 0.01); the average daily MAH was higher by 17.9 ± 3.2 % (p < 0.001), the maximum MAH was 14.37 ± 4.10 % (p < 0.01) and the minimum MAH was 17.07 ± 3.20 % (p < 0.001).
The presented results confirm that all nine indicators that characterize blood pressure during the passive period, were studied in patients with I, II and III degrees of activity, are naturally elevated with the increase in the degree of SLE activity and the most expressive proportional relationship between the increase in the severity of the disease and the magnitude of the studied parameters is in patients of the third group in comparison with the second and especially the first group of patients.
Compared to the ICSC indicators in the active period, SLE patients in the passive period, especially the first and second group, recorded more often than the reference values.
In order to complete the second task, a third step was taken – in patients with different degrees of SLE activity, the measurements of infectious SysAH, DiaAH and MAH for active and passive periods were analyzed (Table 7).
Table 7
Frquency of Increased Systolic, Diastolic and Average Arterial Hypertension Levels During the Passive and Active Period of time for SLE Patients Depending on the Activity of the Disease (n; M ± m; p) 
Notes: * – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ** – р < 0.01 is a Stewdent t-criteria, comparison between 1st and 2nd groups; ## – р < 0.01 is a Stewdent t-criteria, comparison between 2nd and 3rd; ### – р < 0.001 is a Stewdent t-criteria, comparison between 2nd and 3rd; ∆ – р < 0.05 is a Stewdent t-criteria, comparison between 1st and 3rd groups; ∆∆∆ – р < 0.001 is a Stewdent t-criteria, comparison between 1st and 3rd groups.
As we see from tabl. 7 of the six indicators of inflammation in the patients of the three groups only the TI of the SysAH was lower than the referential indexes in the patients of the first group with the first stage of the SLE activity in the active period, and all three indicators in the patients of this group (SysAH, DiaAH andMAH) in the passive period is higher than in the active one.
All six ICSC attributes that characterize AH in the periods of increased incidence of elevated systolic, diastolic and mean arterial pressure during active (TI SysAH, TI DiaAH, TI MAH) and passive (TI SysAH, TI DiaAH, TI MAH) periods in SLE patients have signs of increase with an increase in the degree of disease activity.
However, comparing these indices in patients with the second stage of SLE activity and I, revealed the reliability only on certain parameters – during the active period of the infectious diseases of the SysAH [increased by 102.0 ± 4.7% (p < 0.05)], for the time of the passive period of the infectious sinus transplant [increased by 83.5 ± 7.9 % (p < 0.01)] and infrared transmitter of the passive period [increased by 84.9 ± 7.2 % (p <0.05)].
The next step was to compare the same indices between patients with II and III degrees of activity. During the active period, the infectious SysAH in patients with III activity compared with II was likely to increase by 54.8 ± 8.2 % (p < 0.01), Infantile DiaAH – by 53.8 ± 8.8% (p < 0.01) and MAH – by 60.5 ± 4.6 % (p < 0.001), passive – TI SysAH increased by 52.1 ± 9.7 % (p < 0.05) and TI MAH – by 65.8 ± 10.5 % (p < 0.05).
Comparison of infrared system, DiaAH and MAH for active and passive periods in patients with III activity level, in comparison with I, showed that its indices in all cases are significantly higher than in patients with I degree of activity [in active period of TI SysAH higher than 77.6 ± 7.5 % (p < 0.001), TI DiaAH – by 65.8 ± 8.6 % (p < 0.001) and TI MAH – by 75.7 ± 3.7 % (p < 0.001); in the passive period – the inflammation syndrome was higher at 64.2 ± 9.3 % (p < 0.001), infantile DiaAH – by 52.8 ± 8.3 % (p < 0.05) and TI MAH – by 67.4 ± 10.5 % (p < 0.001)].
Listed in tabl. 5-7 results make it possible to state that of the six indicators of inflammation in the patients of three groups only TI SysAH is lower than the reference indexes in patients with the first group with the first stage of activity of the SLE in the active period and all three indices in the patients of this group (SysAH, DiaAH and MAH) in the passive period is higher than in the active one. All six indicators that characterize inflammation during both active and passive periods are naturally elevated with an increase in the degree of SLE activity and the most expressive is the direct proportional relationship between the increase in the disease severity and the magnitude of the studied parameters in patients of the third group compared with the second and especially with the first group of patients.
Thus, by estimating the average daily, maximum and minimum levels of SysAH, DiaAH and MAH in patients with SLE during active and passive periods, it can be argued that the revealed patterns of changes in the ICSC indicators during the course of the day are preserved and based on the results of their assessment at night and in the afternoon, that in the passive period, the ICSC indicators, especially the first and second groups, were much lower than the reference values.
Of all six (three groups of patients with active and passive periods), the TI indices, indicating the number of measurements, in which the blood pressure exceeded the permissible standards, only the TI of the ICSC was lower than the reference indexes in patients with the first group with the first degree of SLE activity in the active period, and all three indicators (Infrared System, Infrared DiaAH and TI MAH) in patients of this group during the passive period were higher than in the active one. With the increase in the degree of SLE activity, all six indicators that characterize inflammation during both active and passive periods are naturally elevated, and the most directly proportional relationship between the increase in the severity of the disease and the magnitude of the investigated indicators is found in patients with the third group compared to the second and especially the first group.
Conclusion. In patients with systemic lupus erythematosus, indicators of daily blood pressure monitoring depend on the activity of the pathological process – with increasing its degree, the arterial pressure increases significantly in almost all (except for maximal diastolic) indicators, with the change of the physiological circadian rhythm due to its insufficient decrease at night and with an increase in the frequency of episodes in which the blood pressure exceeds the permissible norm. The revealed patterns of change in the indicators of daily blood pressure monitoring over the course of the day are saved by the results of their assessment at night and daytime, with the fact that in the passive period these rates are much more frequent, especially in patients with the first and second stages of disease activity, lower than the reference values.
References
- Kovalenko V, Kornatsky V. Demography and Health Status of the People of Ukraine. Kyiv, 2010. р. 100-110. (Ukrainian).
- Klyukvina N. Systemic Lupus Erythematosus. In: Rheumatology: National Guide. Nasonov E, Nasonova V, editor. Moskow: GEOTAR-Media, 2008. 419 p. (Russian).
- Popkova T, Lisitsina T. Recommendations for Management of Patients with Systemic Lupus Erythematosus in Clinical Practice (according to the materіals of recommendations of European Antirheumatic League – EULAR). Modern Rheumatology. 2011;1:4-12. (Russian).
- Shevchuk S. The Frequency and Spectrum of Cardiovascular Pathology in Patients with Systemic Lupus Erythematosus. Ukrainian Journal of Rheumatology. 2006;4:9-13. (Ukrainian).
- Alves JD, Ames PR. Atherosclerosis, oxidative stress and auto-antibodies in systemic lupus erythematosus and primary antiphospholipid syndrome. Immunobiology. 2003;207(1):23-28. https://doi.org/10.1078/0171-2985-00215
- Stаhl-Hallengren C, Jönsen A, Nived O, Sturfelt G. Incidence studies of systemic lupus erythematosus in Southern Sweden: increasing age, decreasing frequency of renal manifestations and good prognosis. J Rheumatol. 2000;27(3):685-691.
- Ryan MJ. The pathophysiology of hypertension in systemic lupus erythematosus. Am J Physiol Regul Integr Comp Physiol. 2009;296(4):1258-1267. https://doi.org/10.1152/ajpregu.90864.2008