The Hypertension of Hemophilia Is Not Explained by the Usual Cardiovascular Risk Factors: Results of a Cohort Study

Abstract

Background. The etiology of the high prevalence of hypertension among patients with hemophilia (PWH) remains unknown. Methods. We compared 469 PWH in the United States with males from the National Health and Nutrition Examination Survey (NHANES) to determine whether differences in cardiovascular risk factors can account for the hypertension in hemophilia. Results. Median systolic and diastolic BP were higher in PWH than NHANES (P < 0.001) for subjects not taking antihypertensives. Those taking antihypertensives showed similar differences. Differences in both systolic and diastolic BP were especially marked among adults <30 years old. Differences between PWH and NHANES persisted after adjusting for age and risk factors (body mass index, renal function, cholesterol, smoking, diabetes, Hepatitis C, and race). Conclusions. Systolic and diastolic BP are higher in PWH than in the general male population and especially among PWH < 30 years old. The usual cardiovascular risk factors do not account for the etiology of the higher prevalence of hypertension in hemophilia. New investigations into the missing link between hemophilia and hypertension should include age of onset of hypertension and hemophilia-specific morbidities such as the role of inflammatory joint disease.

The hypertension of hemophilia is associated with vascular remodeling in the joint

“…One of our previous studies, comparing a cohort of nearly 600 PWH with gender‐, age‐, and race‐matched subjects from the general population, showed that higher blood pressure measurements were not explained by differences in the usual risk factors. While risk factors such as BMI, smoking, dyslipidemia, diabetes, and renal function were associated with systolic and diastolic blood pressures, their prevalence was similar or lower in PWH compared to the general population. Likewise, infection with hepatitis C or HIV, which are relatively common in older PWH, did not explain higher blood pressures in PWH.…”

“…While risk factors such as BMI, smoking, dyslipidemia, diabetes, and renal function 4,5,7 were associated with systolic and diastolic blood pressures, their prevalence was similar or lower in PWH compared to the general population 5 . Likewise, infection with hepatitis C or HIV, which are relatively common in older PWH, did not explain higher blood pressures in PWH 5 . Furthermore, even after treatment with antihypertensive drugs, PWH still had higher blood pressure values than ordinary males treated with such drugs.…”

“…A marked feature of hemophilia is the higher prevalence of hypertension and higher blood pressures than the general population. Pronounced differences can already be observed in young adulthood. One of our previous studies, comparing a cohort of nearly 600 PWH with gender‐, age‐, and race‐matched subjects from the general population, showed that higher blood pressure measurements were not explained by differences in the usual risk factors.…”

“…While the progression of hemophilic arthropathy can be mitigated by clotting factor replacement therapy, it cannot be entirely abrogated. A marked feature of hemophilia is the higher prevalence of hypertension and higher blood pressures than the general population. Pronounced differences can already be observed in young adulthood.…”

Ischaemic events are rare, and the prevalence of hypertension is not high in Japanese adults with haemophilia: First multicentre study in Asia

“…Numerous articles have reported a higher prevalence of hypertension in PWH than that in the general population. 24,25 In this study, the prevalence of hypertension defined as a blood pressure of ≥140/90 mm Hg was similar in Japanese PWH as compared to that in the general male population (age-adjusted OR 1.164, P = 0.107; Table 3), whereas the prevalence of hypertension defined more strictly as a blood pressure of ≥130/85 mm Hg was significantly lower in the PWH than that in the general male population (age-adjusted OR 0.797, P = 0.014; Table 3). Caution is needed in regard to the following points while interpreting our findings.…”