Background: The prevalence of hypertension in persons with hemophilia (PWH) is reported to be higher compared to the general population in many, but not all, studies examining cardiovascular risk factors in PWH. As life expectancy of PWH increases, an improved understanding of hypertension in PWH is critical.

Aims: To evaluate the role of HTN and associated risk factors in PWH by performing a systematic review of published literature.

Methods: We searched five medical electronic databases for articles on hypertension in hemophilia: PubMed, Web of Science, Embase, Trip and MedNar, screening articles published up to July 30, 2020. ATZ and KAB screened study titles and abstracts, following “Meta-analysis of Observational Studies in Epidemiology” guidelines. We extracted data on hypertension prevalence in both PWH and non-hemophilia comparator populations, hemophilia type and severity, Hepatitis C (HCV) and/or Human Immunodeficiency Virus infection, obesity, diabetes and smoking. Estimates of prevalence and odds ratio (OR) were combined using random-effects models. Heterogeneity in prevalence and OR estimates was examined by fitting meta-regression models.

Results: From 5167 articles, 32 met eligibility criteria; we considered only independent studies, excluding those without numerical data. Hypertension prevalence estimates varied from 5% to 76%; overall prevalence was 39% (95% CI: 31, 47). Large studies (≥ 100 subjects) showed lower prevalence estimates (p = 0.025). Age (p = 0.102, Figure 1), obesity (p = 0.013) and smoking (p = 0.097) in univariate models also explained some variation in prevalence. Meta-regression yielded an overall OR of 1.45 (95% CI: 1.12, 1.87) for hypertension in PWH (n = 16 studies, Figure 2). OR estimates varied from 0.32 to 3.22, but didn’t vary with sample size or risk factors except HCV (p = 0.003).

Meta-regression model illustrating the association between the prevalence of hypertension and median age in each study. The size of the bubbles is proportional to the precision of each study. The slope of the regression line, b = 0.007 (95%CI: -0.002, 0.016, p = 0.102).Forest plot showing odds ratios for 16 studies. The overall OR was 1.45 (95%CI: 1.12, 1.87).

Conclusions: PWH have a higher prevalence of hypertension compared to the general population, not explained by the usual cardiovascular risk factors.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prevalence-of-hypertension-in-hemophilia-patients-a-systematic-review/