Prevalence and Risk Factors Associated With Hypertension in von Willebrand Disease

Mariya H Apostolova; Craig D Seaman; Diane M Comer; Jonathan G Yabes; Margaret V Ragni

doi:10.1177/1076029616670258

Prevalence and Risk Factors Associated With Hypertension in von Willebrand Disease

Clin Appl Thromb Hemost. 2018 Jan;24(1):93-99. doi: 10.1177/1076029616670258. Epub 2016 Sep 21.

Authors

Mariya H Apostolova^{1

2}, Craig D Seaman^{1

2}, Diane M Comer³, Jonathan G Yabes³, Margaret V Ragni^{1

2}

Affiliations

¹ 1 Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
² 2 Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA.
³ 3 Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

Background: von Willebrand factor (VWF) is a biomarker for endothelial damage. Increased VWF levels are observed in hypertension (HTN) and disorders of endothelial dysfunction, for example, atherosclerotic heart disease (ASHD) and diabetes. Whether low VWF protects against HTN is unknown.

Methods: To determine prevalence and risk factors for HTN in patients with von Willebrand disease (VWD), we conducted a cross-sectional analysis of discharge data from the National Inpatient Sample, 2009 to 2011. Group comparisons were performed by Rao-Scott χ² test. Odds of HTN and HTN outcomes in VWD were estimated by weighted multivariable logistic regression.

Results: The prevalence of hypertension in patients with VWD (N = 7556), 37.35%, was significantly lower than that in non-VWD patients (N = 19 918 970), 49.40%, P < .0001. Hypertension risk factors (hyperlipidemia, diabetes, smoking, hepatitis C, and HIV) and HTN outcomes (ASHD, myocardial infarction [MI], ischemic stroke, and renal failure) were less common in patients with VWD than in non-VWD patients, all P ≤ .0001. Patients with VWD were younger, 49.67 versus 57.30 years, Caucasian, 82.23% versus 68.35%, and female, 75.44% versus 59.61%, P < .0001. Patients with HTN were older, 67.55 versus 47.29 years, male, 45.99% versus 34.90%, and had more HTN risk factors and HTN outcomes than those without HTN, all P < .0001, including male and female subgroups, each P < .0001. The unadjusted odds of HTN in patients with VWD (odds ratio [OR] = 0.611, P < .0001) and of HTN outcomes in patients with VWD (ASHD, OR = 0.509; MI, OR = 0.422; ischemic stroke, OR = 0.521; renal failure, OR = 0.420, all P < .0001) became insignificant after adjustment for HTN risk factors plus demographics (age/race/gender), OR = 1.035, P = .260.

Conclusion: The risk of HTN is reduced in patients with VWD, but not after adjustment for HTN risk factors plus demographics, as patients with VWD not having HTN are also typically young, Caucasian, and female.

Keywords: atherosclerosis; cardiovascular disease; endothelial damage; essential hypertension; von Willebrand disease; von Willebrand factor.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Age Factors
Female
Humans
Hypertension* / epidemiology
Hypertension* / etiology
Hypertension* / physiopathology
Male
Middle Aged
Prevalence
Risk Factors
von Willebrand Diseases* / complications
von Willebrand Diseases* / epidemiology
von Willebrand Diseases* / physiopathology