Diabetes, HIV Can Lead to High Blood Pressure With Hemophilia

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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Diabetes and infection with human immunodeficiency virus (HIV) increase the risk of high blood pressure (hypertension) among men with hemophilia, a U.S. study found.

Given that both hypertension and diabetes can lead to a brain bleed in hemophilia patients, these findings support early screening for these conditions in this patient population, the researchers noted.

The study, “Diabetes, hepatitis C and human immunodeficiency virus influence hypertension risk differently in cohorts of hemophilia patients, veterans and the general population,” was published in the journal Haemophilia.

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People with hemophilia, a bleeding disorder caused by deficiencies in blood clotting factors, have a greater risk of brain bleeding than the general population.

“Consequently, high blood pressure is of particular concern for clinicians in hemophilia treatment centers,” the researchers wrote.

“Diabetes is also a concern,” the team added, because hypertension and diabetes-induced blood vessel defects “are both risk factors” for bleeding in the brain.

Role of diabetes in hypertension risk

Previous studies have reported that hypertension is more common in hemophilia patients than in the general population. However, common cardiovascular risk factors do not seem to play a role in the increased risk.

Diabetes, a known risk factor for heart disease, infection with hepatitis C (HCV), and HIV infection have each been shown to be risk factors for hypertension in the general population. Notably, both viruses have a high prevalence among people with hemophilia.

However, “little is known about the prevalence of diabetes in PWH [people with hemophilia] and its relation to other [simultaneous health conditions],” the researchers wrote.

A team led by researchers at University of California San Diego assessed the role of diabetes, HCV, and HIV in hypertension among hemophilia patients.

They retrospectively analyzed the clinical data of 691 men with hemophilia (ages 18–79) followed at four hemophilia treatment centers in North America between 2003 and 2014.

Patients were divided into two groups. Group A included those without diabetes, HCV or HIV infection (217 men; median age of 27), while group B comprised patients with diabetes or a history of HCV or HIV infection (414 men; median age of 46).

Each group was compared to men, matched by race and age, participating in the US National Health and Nutrition Examination Surveys (NHANES) — reflecting the general U.S. adult male population — and outpatients at the Veterans Affairs Medical Center (VAMC) in San Diego.

NHANES and VAMC participants were also divided into groups A and B in agreement with their diabetes, HCV, and HIV status. A groups included 2,170 NHANES participants and the same number of veterans. B groups included 391 NHANES participants and 414 veterans.

Results showed that hypertension was more frequent among hemophilia patients (50.1%) relative to the general adult male population (25.5%) and veterans (41.2%), while diabetes was less common (7.8% vs. 12.6–13.7%).

Among men with hemophilia, hypertension was more frequent in group B than in group A (57% vs. 37%), suggesting that the presence of diabetes or these viruses increased the risk of high blood pressure.

When comparing all three A groups (diabetes- and virus-free), the researchers found that hypertension was the highest among hemophilia patients (37%), followed by veterans (34%) and NHANES participants (20%).

Of note, men with hemophilia in their 20s and those in their 60s showed a much higher risk of hypertension relative to veterans and those in the general population. Between those ages, their risk remained generally higher than those in the general population, but lower than that of veterans.

“Although there is currently no solid explanation regarding the early onset of hypertension in hemophilia, one may speculate that this finding supports the concept that hemophilia-specific factors rather than general risk factors play a role,” the researchers wrote.

Data from participants across the three B groups (diabetic and/or virus-positive) revealed that 77% of veterans had high blood pressure, compared with 53% of the NHANES participants and 57% of hemophilia patients.

Men with hemophilia had the highest rates of HCV infection (97% vs. 10–14%) and HIV infection (30% vs. 4–13%), but the lowest of diabetes (12% vs. more than 80% in both groups).

Still, the presence of diabetes was found to be the factor contributing most to hypertension, even in men with hemophilia. HIV infection was the second highest contributing factor among these patients.

Hemophilia patients “with either diabetes or HIV showed a pronounced increase in hypertension risk compared to PWH who were either virus-free or infected with HCV only,” the researchers wrote.

“The effects of diabetes or HIV infection on hypertension risk were not as marked in NHANES and VAMC subjects,” the team wrote, adding that “reasons for the disproportionate increase in hypertension risk related to diabetes and HIV in PWH remain unclear.”

Among hemophilia patients, HCV infection increased the risk of hypertension only among middle-aged men (40–60 years). In turn, the presence of this virus was a major factor contributing to hypertension in veterans and in the general adult male population.

Study findings “show that both diabetes and HIV infection amplify the risk of hypertension for PWH, while HCV infection has less effect,” the researchers wrote.

“Our findings should raise awareness regarding early hypertension and diabetes screening, to ensure timely blood pressure and [blood sugar] control, with the ultimate goal of further reducing morbidity and mortality” in hemophilia patients, the team concluded.