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Investigators Look at Hematuria as Hypertension Risk Factor in Hemophilia Patients

May 7, 2020
Investigators Look at Hematuria as Hypertension Risk Factor in Hemophilia Patients

Findings from an international study published in the journal Medicine suggest that the visible presence of blood in urine (macroscopic hematuria) could represent increased risk for individuals with hemophilia and a family history (FH) of high blood pressure, otherwise known as hypertension. The observational study was led by Christian Qvigstad, MD, Department of Haematology at Oslo University hospital in Norway.

Qvigstad and his fellow authors looked at data from the previously completed H3 study, conducted by the ADVANCE (Age-related DeVelopments ANd ComorbiditiEs in hemophilia) Working Group. ADVANCE consists of experienced hemophilia clinicians from across Europe who work to raise awareness of issues related to the aging hemophilia population and to consider how current management strategies should best be adapted to their needs. The study was performed at 16 hemophilia treatment centers based primarily in Europe, where patient data was collected between June 2011 and September 2013.

Included in their analysis were 532 patients, 87%, with hemophilia A, and 13% with hemophilia B. More than half (58%) had severe hemophilia, 11% had moderate, and 31% were mild. The age range of the participants was 40-98 (median age 52). Results of blood pressure measurements indicated that overall, 239 patients had a known diagnosis of hypertension, 290 did not have high blood pressure, with values missing for the remaining three people.

Among the hypertensive group, 117 reported FH, 75 reported no history, while the remaining 50 had no data to report. Prophylactic therapy regimens were more common in those patients with, than in patients without FH of hypertension (41% vs. 25%). Hypertensive patients with FH also had higher rate of macroscopic hematuria (67%) compared to other patients (51%). The authors also found that patients with macroscopic hematuria were almost twice as likely (1.84 times) to develop hypertension if they had FH of high blood pressure.

Ovigstad also noted that the rate of risk for hypertension in participants with FH increased along with the number hematuria episodes, as they observed a 1.98 times greater risk for less than three bleeding episodes, and a 3.14 times greater risk for more than 10 episodes.

They note the potential significance for some individuals with hemophilia. “It has generally been thought that macroscopic hematuria is a benign condition in people with hemophilia. However, this paper demonstrated its association with hypertension FH+. This result is clinically important as hypertension in turn can lead to further renal damage, cardiac disease, peripheral vascular disease, and stroke. An increased attention given to macroscopic hematuria may restrict these adverse outcomes.” explained the authors.     

Ovigstad and his fellow researchers also acknowledged several limitations, such as the small sample size of the study on which they based their observations. “We acknowledge that the results pertain to this study sample only and encourage more research to establish out of sample evidence to ascertain whether the association between hypertension FH+ and hematuria holds more generally,” concluded the authors.

“Macroscopic Hematuria as a Risk factor for Hypertension in Ageing People with Hemophilia and a Family History of Hypertension,” was published in the February 2020 issue of Medicine.

Source: Hemophilia News Today, April 17, 2020