Haematuria is not a risk factor of hypertension or renal impairment in patients with haemophilia.

INTRODUCTION: An increased prevalence of hypertension has been reported in patients with haemophilia compared to the age-matched general population, although the causes were unclear. To date, there has been limited data implicating haemophilia-specific risk factors such as renal bleeding. AIM: This two-centre prospective cohort study aimed to assess the prevalence of gross/microscopic haematuria, and the associations between haematuria, blood pressure and renal function. METHODS: Of 135 adult males, with mild to severe haemophilia followed by the British Columbia and University of California San Diego Hemophilia Treatment Centers were included. Screening urinalysis and microscopy were performed during all routine visits. Haematuria was defined as history of gross haematuria or >3 red blood cells per high-power field on microscopy in the absence of urinary tract infections. Logistic regressions were used to examine the significance of haematuria and other potential hypertension risk factors. RESULTS: The prevalence of hypertension was 44%, of whom 31% achieved adequate blood pressure control. Despite the high prevalence of haematuria (34%), renal dysfunction was rare. On univariate analysis, age, diabetes, dyslipidemia and obesity were associated with hypertension. On multivariate analysis, only age remains as a significant predictor of hypertension. Haematuria was not associated with hypertension, renal insufficiency or haemophilia severity. CONCLUSION: In this cohort, hypertension and haematuria were prevalent while renal disease was rare. Haematuria was not associated with a diagnosis of hypertension or renal dysfunction. Larger prospective studies are needed to elucidate the mechanisms for increased prevalence of hypertension in haemophilia.

Risk assessment for coronary heart disease in patients with haemophilia: a single centre study in the United States.

In haemophilia, coronary heart disease (CHD) occurs at a similar frequency as in the general population, but the contributing risk factors in haemophilia are incompletely understood. To investigate risk factors and 10-year CHD risk in a single centre cohort of patients with haemophilia (PWH) ≥20 years old (n = 89). We retrospectively applied the modified Framingham National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP) III risk prediction equation. Three risk levels were defined: <10% (low), 10-20% (intermediate) and >20% (high). Results were compared to the National Health and Nutrition Examination Survey (NHANES). Mean age in both cohorts was similar. Compared to NHANES, systolic blood pressures were significantly higher in PWH, but current smoking and cholesterol were lower. CHD risk differed significantly between PWH and NHANES (P = 0.005) with a higher proportion of PWH classified at low risk (77.5% vs. 61.0%). The proportion of low risk patients was also significantly higher for severe haemophilia patients compared to non-severe haemophilia patients (88.6% vs. 66.7%, P = 0.02). Among PWH, and compared to PWH who were hepatitis C (HepC) negative, HepC positive patients had significantly lower cholesterol, LDL and triglycerides. The CHD risk of HepC positive patients differed significantly from NHANES (P = 0.03) with a lower proportion of HepC positives being classified as high risk (5.7% vs. 17.3%). Favourable CHD risk classification in PWH may be influenced by low cholesterol associated with HepC infection. Estimates of CHD risk in PWH by composite scoring may not be accurate and will require studies correlating risk factors with incident CHD.