Department of Medicine, University of California San Diego, San Diego, California, USA.
Department of Primary Care, Veterans Affairs Medical Center, San Diego, California, USA.
Haemophilia. 2022 Nov;28(6):e228-e236. doi: 10.1111/hae.14637. Epub 2022 Jul 25.
The reasons for the high prevalence of hypertension in persons with haemophilia (PWH) are poorly understood.
To examine the roles of diabetes, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) in the etiology of hypertension for PWH.
Retrospective cross-sectional design. Adult PWH (n = 691) were divided into two groups: (A) free of diabetes, HCV and HIV; (B) with diabetes and/or HCV positivity and/or HIV positivity. Each group was matched by race and age with random samples from the general population of the US (National Health and Nutrition Examination Surveys, NHANES) and outpatients at the Veterans Affairs Medical Center (VAMC) in San Diego. Generalized additive models (GAMs) were fitted for graphical analysis of hypertension risk over the lifespan.
In Group A, PWH had the highest prevalence of hypertension compared to NHANES and VAMC, especially in young adults. In Group B, diabetes increased the risk of hypertension for all three cohorts (PWH, NHANES and VAMC), especially for PWH. In PWH, hypertension risk was also increased by HIV, in NHANES by HCV, and in VAMC by HCV and HIV.
Diabetes conferred the greatest risk of hypertension for all three cohorts. However, curves of hypertension in relation to age revealed that diabetes, HCV and HIV modulated hypertension risk differently in PWH. PWH experienced a disproportionally high risk increase with diabetes. Therefore, haemophilia care should include screening for hypertension and diabetes at a young age.
导致血友病患者（PWH）高血压高发的原因尚未明确。
探究糖尿病、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）在 PWH 高血压发病机制中的作用。
回顾性队列设计。将 691 例成年 PWH 分为两组：（A）无糖尿病、HCV 和 HIV；（B）患有糖尿病和/或 HCV 阳性和/或 HIV 阳性。每组均按种族和年龄与美国普通人群（国家健康和营养检查调查，NHANES）和圣地亚哥退伍军人事务医疗中心（VAMC）的门诊患者进行随机匹配。采用广义加性模型（GAMs）进行图形分析，以评估整个生命周期内的高血压风险。
在 A 组中，与 NHANES 和 VAMC 相比，PWH 的高血压患病率最高，尤其是在年轻成年人中。在 B 组中，糖尿病增加了所有三个队列（PWH、NHANES 和 VAMC）的高血压风险（PWH 尤其如此）。在 PWH 中，HIV 也增加了高血压风险，在 NHANES 中 HCV 增加了高血压风险，在 VAMC 中 HCV 和 HIV 都增加了高血压风险。
糖尿病使所有三个队列的高血压风险都显著增加。然而，与年龄相关的高血压曲线表明，糖尿病、HCV 和 HIV 对 PWH 的高血压风险的调节方式不同。PWH 的糖尿病风险增加比例不成比例。因此，血友病的治疗应该包括在年轻时筛查高血压和糖尿病。
