The editor's roundtable: effect of nonsteroidal anti-inflammatory drugs on blood pressure

Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases

Evidence for the increased risk of cardiovascular morbidity and mortality in patients with chronic inflammatory and systemic autoimmune diseases has accumulated during the past 15 years. In these patients, an interplay between several mechanisms, including premature acceleration of subclinical atherosclerotic damage, inflammation, and dysregulation of the immune system, is involved in the induction and progression of atherosclerosis. Moreover, traditional cardiovascular risk factors are also likely to contribute, at least in part, to the excess cardiovascular risk. Among traditional cardiovascular risk factors, hypertension is an important predictor of cardiovascular events in the general population and in patients with chronic inflammatory and autoimmune diseases. Evidence supports the idea that the pathogenic mechanisms underlying the increased blood pressure in these diseases are multifactorial and not only related to the mechanical injury of the arterial wall. In particular, chronic inflammation and immune-mediated mechanisms have been demonstrated to affect blood-pressure control in patients with systemic autoimmune disease. In this Review, we discuss the available evidence on the relationship between hypertension and autoimmune diseases, and describe the multiple factors that might affect blood-pressure control in patients with chronic inflammatory and systemic autoimmune diseases. We also discuss the effect of hypertension and antirheumatic therapies on cardiovascular outcome.

Normative blood pressure and heart rate in pediatric spinal cord injury

BACKGROUND

Cardiovascular measures in children with spinal cord injury (SCI) may vary depending on the child's age and physical development in addition to injury-related factors. Developmental changes should be considered when addressing cardiovascular complications in this population.

OBJECTIVES

To determine baseline blood pressure (BP) and heart rate (HR) measurements in youth with SCI, and to investigate differences in BP and HR in relation to age, gender, body mass index (BMI), and injury-related factors.

METHODS

Retrospective chart review was conducted for youth under 19 years who had been admitted for rehabilitation at 1 of 2 pediatric SCI programs. Systolic (SBP) and diastolic (DBP) blood pressures and HR were collected in the morning and afternoon on 3 consecutive days. Mean SBP, DBP, and HR were compared among 4 age groups (0-5 years, 6-12 years, 13-15 years, and 16-18 years) and by gender. Diurnal variations were determined according to level and severity of injury. Associations with BMI and injury-related factors were examined. Charts of 315 youths were reviewed: mean age was 12.3 years, 59% were male, 75% were Caucasian, 62% had complete injury, and 66% had paraplegia.

RESULTS

With increasing age, SBP and DBP increased and HR decreased. SBP and DBP were positively correlated with BMI. SBP was higher in males, those with incomplete injury, and those with paraplegia. HR was higher in females. There was no association between cardiovascular measures and injury duration.

CONCLUSION

BP and HR are a function of age, BMI, and completeness and level of injury in youth with SCI. Awareness of baseline measures will allow for more effective management of cardiovascular complications, especially in youth presenting with atypical symptoms.

Antiplatelet therapy in acute coronary syndromes: current agents and impact on patient outcomes

Platelets play a central role in atherothrombosis and subsequent development of acute coronary syndromes (ACS). The understanding of this process has driven a large body of evidence demonstrating the mortality and morbidity benefits of antiplatelet agents in the ACS population. As expected, however, these agents come with an intrinsically increased risk of bleeding which underlies the vast majority of their complications and adverse effects. In today’s setting of compounding comorbidities and broadening indications, finding the balance between thrombosis prevention and bleeding risk remains the challenge for all clinicians considering these medications. This article reviews the current main antiplatelet agents that are available for clinical use and outlines their impact on ACS outcome. We also outline factors which affect the response to these agents and discuss strategies to optimize clinical outcomes.