Recent epidemiological research and examination of insurance databases have revealed that individuals with hemophilia are more likely to develop essential hypertension and at a younger age compared to people of their same age and gender who don’t have hemophilia.
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Living with hemophilia requires confronting a set of well-documented challenges. Individuals with this rare bleeding disorder are typically well-versed with recognizing and treating joint bleeds and other bleeding complications and they learn how to self-administer clotting factor concentrates to reverse or prevent these events, said Dr. Craig Kessler, a hematologist and co-editor of the medical journal Haemophilia. They also understand that non-compliance in their prophylaxis regimens will lead to long term consequences such as joint damage and pain, he added.
“Patients with hemophilia are also aware of the risks of developing alloantibody inhibitors against factor VIII or IX,” he said.
On the other hand, there has been less recognition that hemophilia also can be associated with non-bleeding and non-infectious disease related complications. Hematologists from Hemophilia Treatment Centers have recently described a new medical concern: a higher than expected prevalence of hypertension, or high blood pressure, in individuals with hemophilia.
Hypertension is something everyone should be aware of as they age, but observational research and examination of insurance databases have revealed that this condition is showing up more frequently, and at younger ages, in people with hemophilia.
“We anticipate that the earlier onset of hypertension in our patients will lead to major long term heart and kidney health consequences as individuals with hemophilia live longer,” said Dr. Kessler.
Hypertension can lead to a host of serious medical issues, including heart disease, strokes and kidney issues,” said Dr. Birgit Voelker, the Director of Global Medical Affairs for Commercial Development Hematology at CSL Behring.
“In view of their increased risk of bleeding, hemophilia patients with hypertension should be treated adequately and have their blood pressure checked regularly,” she added.
While the evidence of a connection between hypertension and hemophilia is strong, doctors have yet to determine the reason behind it. In the general population, age, gender and race play a part in hypertension as well as controllable factors like weight, diet, exercise and alcohol and tobacco use. But one study found those risk factors don’t completely explain why hypertension is so prevalent in individuals with hemophilia and why this occurs at a younger age.
If left unchecked, however, the traditional risk factors could still lead to hypertension for those with hemophilia. That’s why Dr. Kessler, who runs the hemophilia treatment center (HTC) at the Georgetown University Lombardi Comprehensive Cancer Center in Washington, D.C., believes doctors should encourage healthy lifestyle activities for people with hemophilia at younger ages, like exercise and maintaining a healthy weight.
“This is a problem that begins in early adolescence,” he told Vita. ”It’s critical that our pediatric hematologists become aware of this medical issue so that they can intervene early on.”
The issue is so significant, added Dr. Kessler, that it may stimulate a “sea change” in the way that comprehensive hemophilia care will be delivered in the future. For instance, HTCs of the future may need to include evaluations by cardiologists, nutritionists, and bariatric physicians in addition to the physical therapist. Successfully addressing these problems early will lead to long term benefits.
“We need to get smarter about managing hypertension,” he said.
The call for comprehensive treatment is echoed by Dr. Voelker, who says people with hemophilia should be cared for through a management plan developed by a multidisciplinary team of experts.
“Communication among treaters is immensely important,” she said.
Improved hemophilia treatments mean people with the disease are living longer. Children born with the condition today can look forward to a nearly normal life expectancy with treatment. But, according to Dr. Kessler, not enough research has been conducted to find out how the diseases of aging, like hypertension, will affect people with hemophilia.
Dr. Kessler believes individualized and preventive medicine “are the keys” in treating hypertension in patients with hemophilia, but adds that larger studies and more funding are required to address the overarching issue.
“We’re very early into this issue of aging and hemophilia, and still have much to learn about best treatment practices for these patients,” he said.