Management for hypertension in systemic sclerosis

Refer people with systemic sclerosis presenting with hypertension (on regular screening or self-monitoring) urgently to their specialist. Even if the person is asymptomatic, their blood pressure (BP) can rapidly escalate to accelerated hypertension. If a person with systemic sclerosis presents with any symptoms of hypertension (eg headache, dizziness, visual disturbance), check their BP urgently. Patients may also present with acute pulmonary oedema.

Note: Refer people with systemic sclerosis presenting with hypertension (even if mild or asymptomatic) urgently to their specialist for immediate management, as blood pressure can rapidly escalate to accelerated hypertension.

For people who have essential hypertension and systemic sclerosis (rather than accelerated hypertension or scleroderma renal crisis), the preferred first-line antihypertensives are calcium channel blockers or angiotensin II receptor blockers. Beta blockers¹, ACEIs and diuretics should not be used long term in patients with systemic sclerosis. Studies have demonstrated that prophylactic antihypertensive treatment with ACEIs can be harmful for people with systemic sclerosis and is not recommendedKowal-Bielecka, 2017.

Note: Angiotensin converting enzyme inhibitors (ACEIs), beta blockers and diuretics are not recommended for long-term, prophylactic antihypertensive treatment in people with systemic sclerosis.

¹ Beta blockers are not recommended for people with systemic sclerosis because they can worsen Raynaud phenomenon and digital ischaemia.Return