Heart disease is the leading cause of death in both the general population and in people with systemic lupus erythematosus (SLE), the most common form of lupus. Hypertension (high blood pressure) is a major risk factor for heart disease, and studies suggest that up to half of people with lupus develop high blood pressure. Given this connection, it’s no surprise that hypertension is a common topic of discussion on MyLupusTeam. “Today, my blood pressure is extremely high, and I feel it. Before lupus, I didn’t have blood pressure issues,” said one member.

Lupus can significantly impact the cardiovascular system, making it important to understand these risks. Recognizing how lupus contributes to high blood pressure can help you take proactive steps to manage it — protecting both your heart and your overall well-being.

Understanding High Blood Pressure

High blood pressure occurs when the force of blood against the artery walls is consistently too high. Over time, untreated hypertension can strain the heart and damage blood vessels, increasing the risk of complications, including:

• Kidney failure
• Heart attack
• Stroke
• Heart failure

“Today, my blood pressure is extremely high, and I feel it. Before lupus, I didn’t have blood pressure issues.”

— A MyLupusTeam member

Since high blood pressure often develops without noticeable symptoms, regular monitoring is essential. When you measure your blood pressure, you’ll see two numbers.

The first number is called systolic blood pressure. Each time the heart beats, blood is pumped from the heart and out to the rest of the body. Blood carries oxygen and nutrients to every organ system, including your brain, muscles, and lungs. Systolic blood pressure measures how much pressure is pushing against the inside of your arteries with every heartbeat.

The second number is your diastolic blood pressure. This is how much pressure is in your arteries between heartbeats. Diastolic blood pressure is a smaller number than systolic blood pressure because it does not measure the active push of blood. Both systolic and diastolic pressure numbers can help diagnose high blood pressure.

What Is Considered Normal or High Blood Pressure?

Blood pressure is classified as normal when the systolic pressure is less than 120 millimeters of mercury (mm Hg) and the diastolic pressure is less than 80 mm Hg. According to the American Heart Association (AHA), blood pressure falls into the following categories:

• Normal blood pressure — Systolic less than 120 mm Hg and diastolic less than 80 mm Hg
• Elevated blood pressure — Systolic between 120-129 mm Hg and diastolic less than 80 mm Hg
• Hypertension stage 1— Systolic 130 mm Hg or higher or diastolic 80 mm Hg or higher
• Hypertension stage 2 — Systolic 140 mm Hg or higher or diastolic 90 mm Hg or higher
• Hypertensive crisis (medical emergency) — Systolic 180 mm Hg or higher and/or diastolic 120 mm Hg or higher

If your blood pressure falls into the elevated or hypertensive range, talk to your doctor about lifestyle changes and possible treatment options to lower your risk of heart disease and other complications.

The Impact of Inflammation

Lupus is an autoimmune disease in which the body’s immune system attacks healthy tissues mistakenly, triggering chronic inflammation and potential organ damage. Chronic inflammation from lupus can damage blood vessels and contribute to atherosclerosis — the buildup of plaques inside arteries. This process can increase the risk of high blood pressure by making arteries stiff or narrow, reducing blood flow.

High blood pressure can sometimes be a sign of a lupus flare-up (periods of active symptoms) or indicate damage to key organ systems, such as blood vessels and kidney function. When lupus affects the kidneys, it can interfere with their ability to regulate fluid balance, leading to edema (fluid retention) and increased blood pressure.

Many people with lupus notice changes in their blood pressure during flares. “Any time my body is out of whack, my blood pressure tends to rise some. The doctor said that it was my body’s response to the inflammatory process,” shared a MyLupusTeam member.

“I’m in a flare, and it always makes my blood pressure higher,” said another member.

Lupus Nephritis

One serious complication of lupus is kidney inflammation, known as lupus nephritis. When kidneys are inflamed, they can’t filter waste products and excess fluids from the blood as effectively. This can lead to high blood pressure, a common sign of lupus nephritis.

Other symptoms of lupus nephritis include:

• Foamy urine due to proteinuria (high levels of protein in the urine)
• Red, pink, or brown urine due to hematuria (blood in the urine)
• Swelling in the legs, feet, or hands from edema

“I’m in a flare, and it always makes my blood pressure higher.”

— A MyLupusTeam member

Sudden weight gain can be a sign of swelling from poor kidney function. “I had so much swelling I had to buy larger shoes,” explained a MyLupusTeam member. “My heart rate was in the 40s, and the heart doctor insisted I needed a pacemaker. When I asked him what was causing the swelling, he said maybe I was just one of those older ladies that just naturally have swollen legs. I was having bad breathing problems, and my primary care doctor kept insisting my lungs looked good. He finally sent me to a pulmonologist who said I had fluid around my lungs. I was carrying about 40 pounds of excess fluid in my body.”

Who Is at Risk for Lupus Nephritis?

Around 50 percent of all people with SLE develop lupus nephritis. Although lupus is more common among women overall, according to Mayo Clinic, males with lupus have a relatively higher risk of lupus nephritis. In addition, Black, Hispanic, and Asian American people with SLE are at a higher risk for lupus nephritis than white people, per Mayo Clinic.

How Is Lupus Nephritis Diagnosed?

Lupus nephritis requires careful monitoring by a nephrologist, a specialist in kidney diseases. Diagnosis typically involves:

• Urine tests to check for protein and blood in the urine
• Blood tests to assess kidney function
• A kidney biopsy, in which a small tissue sample is removed and examined under a microscope to confirm inflammation and determine the severity of kidney damage

How Is Lupus Nephritis Treated?

There is no cure for lupus nephritis. Treatment typically focuses on reducing kidney inflammation, protecting kidney function, and preventing further damage. Common treatment options include blood pressure medications, immunosuppressive medications, and biologics. If lupus nephritis progresses to more advanced kidney disease or kidney failure, more intensive treatments may be required. These may include dialysis (a treatment that filters waste and excess fluids from the blood) or a kidney transplant (replacing a kidney with a healthy one from a donor).

Lupus Medication Side Effects

Many people with lupus take medications to control inflammation and prevent organ damage, but some of these treatments can have unwanted side effects, including high blood pressure.

One of the most commonly used lupus treatments is corticosteroids, such as prednisone or methylprednisolone. While effective at reducing inflammation, long-term corticosteroid use — especially at high doses or through intravenous administration — can increase blood pressure. Corticosteroids can also promote plaque buildup in the arteries, which raises the risk of cardiovascular disease.

Other lupus medications that may contribute to high blood pressure include cyclosporine (Gengraf, Neoral, or Sandimmune). Cyclosporine is an immunosuppressant that can cause increased blood pressure and kidney strain.

Fortunately, not all lupus medications are harmful to your heart. In fact, hydroxychloroquine (Plaquenil) — a cornerstone in lupus treatment — has been shown to reduce the risk of thromboembolic events (blood clots) by 49 percent, according to a large-scale study from 2022.

People with lupus should regularly monitor their blood pressure and talk to their healthcare provider if it starts to rise. Even if stopping a lupus medication isn’t an option, your rheumatologist may adjust your dosage or recommend additional strategies to help manage your blood pressure.

Managing High Blood Pressure

Lifestyle choices play a key role in controlling blood pressure. In addition to essential habits like not smoking and maintaining a healthy body weight, making targeted adjustments to your diet, exercise routine, and stress management can have a significant impact.

Diet for Managing High Blood Pressure

Excess sodium (salt) intake directly contributes to high blood pressure. The average American consumes significantly more sodium than necessary — often more than 20 times the minimum required intake for basic body functions. Most of this extra salt comes from processed and restaurant foods.

Examples of high-sodium foods to limit:

• Canned foods — Choose low-sodium or no-salt-added varieties.
• Fast food and restaurant meals — Cooking at home with fresh ingredients can help reduce sodium intake.
• Frozen and prepared meals — Learn to navigate food labels and choose lower-sodium options.
• Salty snacks — Swap for unsalted nuts or fresh fruit.
• Smoked or cured meats — Season fresh meats with lemon, garlic, or herbs instead of salt.

For people with kidney involvement, managing protein intake and incorporating more plant-based foods can slow the progression of kidney disease and help regulate blood pressure.

A registered dietitian nutritionist (RDN) can help tailor a low-sodium, kidney-friendly meal plan and suggest recipes that fit your needs.

Exercise for Managing High Blood Pressure

Regular physical activity strengthens the heart and improves circulation, helping to regulate blood pressure. Health experts recommend at least 30 minutes per day. Unfortunately, achieving this can be challenging for people with lupus-related joint pain and fatigue.

To stay active while managing lupus:

• Start small — Set realistic goals and gradually increase activity levels.
• Find what works for you — Low-impact exercises like walking, swimming, or yoga can be easier on the joints.
• Listen to your body — Some days will be harder than others. Adjust as needed to avoid overexertion.

Keep Your Doctor in the Loop

Despite following a heart-healthy lifestyle, some people still struggle with high blood pressure. Hypertension can be genetic or influenced by factors beyond your control, like lupus. In these cases, blood pressure medications may be necessary to keep your numbers within a safe range.

Regular checkups with your healthcare team are essential to managing both lupus and blood pressure. Keeping lupus under control can help prevent flares and reduce the need for medications that may raise blood pressure. A cardiologist (heart specialist) may also be involved in your care to adjust treatments and prevent further complications.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 234,000 people with lupus come together to ask questions, give advice, and share their stories.

Did you experience high blood pressure after getting diagnosed with lupus? If so, have you taken steps to lower your blood pressure or preserve your kidney health? Post your thoughts in the comments below, start a conversation by sharing on your Activities page, or connect with like-minded members in Groups.