Pak J Physiol 2016;12(2)

ORIGINAL ARTICLE
ASSOCIATION OF ABO AND Rh BLOOD GROUPS
WITH HYPERTENSION
Manjeet Kaur, Kawalpreet Gill*, Roopam Bassi, Deepinder Kaur
Department of Physiology, *Community Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India

Background: Hypertension has been termed ‘silent killer’ a chronic illness with adverse effects
principally involving the central nervous system, the retina, the heart and the kidneys. Since
hypertension is multifactorial, the ABO antigens may indirectly influence arterial pressure. This study
was conducted to evaluate the prevalence of ABO and Rh blood groups among controls and
hypertensives to assess the relationship between hypertension and blood group. Methods: This cross-
sectional study included 300 apparently healthy, normotensive controls and 500 hypertensive subjects.
The basal blood pressures were determined using palpatory and auscultatory method in both control
and hypertensive group and their blood groups were determined using the slide haemagglutination
technique. Statistical analysis was done using Chi-square test. Results: The frequency of ABO blood
groups in both control and hypertensive group was found to be B>O>A>AB. The prevalence of blood
group B and O was found to be increased in hypertensive group by 3%, prevalence of blood group A
and AB was found to be decreased by 4.3% and 1.5% respectively, but was not significant statistically
(p>0.05). Conclusion: There is no correlation of developing hypertension with a particular blood group.
Keywords: Hypertension, ABO blood group, Rh blood group
Pak J Physiol 2016;12(2):11–4

INTRODUCTION Rhesus (Rh) positive, while persons without antigen D

in their RBCs are termed Rh negative.8,9 Immunological
Hypertension is an asymptomatic condition, therefore
characteristics determine and classify the differentiation
people are unaware of their high blood pressure. This is
of blood by type.10
the main reason that it remains undetected leading to
Studies have shown that various blood group
organ damage. It is estimated to cause 7.1 million deaths
phenotypes have been implicated in increased
globally (13% of total).1 In developing countries,
susceptibility to certain diseases11, e.g., Helicobacter
hypertension is on the rise due to the increase in
pylori and increased risk of peptic ulcer12,13, haemolytic
urbanization and adoption to western lifestyles.2
uremic syndrome, and Escherichia coli14, elevated
Hypertension in adults affects the quality of life of
serum antibody titer levels to Vibrio cholera15,
people and economic burden of the country.3 People get
carcinomas16 and infertility in women17. Thus its
aware of being hypertensive only after developing its
frequency distribution follows a known pattern governed
complications.
by gene transmission, and varies with the race and
Diagnosis of hypertensive patients is very
geographical distribution of human being.18
important as it can easily be prevented by recognizing
Familial patterns of primary hypertension
its probable risk factors.4 Hypertension is dependent on
suggests that there could be some genetic factors for the
modifiable and non-modifiable factors. Obesity and
development of hypertension. There are reports of
weight gain are the strongest modifiable independent
increased cardiovascular (CV) risks in different blood
risk factors in developing hypertension.5 Familial
groups and increase in BP is considered as a common
patterns of hypertension suggests genetic factor as
CV risk. The ABO system is one such genetic make-up
another important non-modifiable predisposing factor,
that can provide much valuable information for early
and ABO blood group is one such factor which needs to
detection of vulnerable groups.
be investigated in more details.
Some studies suggest that those carrying the
The ABO blood groups are determined by
ABO blood group sublet A19,20, group B21–23, group O24–
presence or absence of antigen A and B on membrane of 26
have a greater risk of developing hypertension. On the
human red blood cell. These blood group antigens,
contrary, some studies27,28 could not find relevant data in
which are actually complex oligosacharide differ in their
favour of subjects with the ABO blood group being
terminal sugar.6 The antibodies against red blood cell
susceptible to hypertension. Though the blood type
antigens are called agglutinins, which are present in the
cannot be modified as a risk factor, having knowledge
sera of individuals whose red cells lack corresponding
of the relationship between blood groups and heart
antigen. The presence of these antigens and agglutinins
disease can help to improve the control of other
in individuals, divides them into 4 major blood groups
modifiable risk factors of developing hypertension.
A, B, AB and O.6,7 In addition, if human RBCs contain
another important antigen D, the blood is known as

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 Pak J Physiol 2016;12(2)

The objectives of this study were to evaluate study subjects showing blood group B (39.6%),
the prevalence of hypertension in various ABO and Rh followed by O (34.6%), A (20%), and AB (5.8%). The
blood group subjects, and to see any association percent distribution of ABO blood groups in the Total
between ABO and Rh blood groups with hypertension. study group of 800 was found to be (38.5%) blood
group B, (33.5%) O, (21.62%) A, and (5.12%) AB.
SUBJECTS AND METHODS There was an increase in prevalence of hypertension by
It was a crosssectional study carried out in two groups 3% in blood group B and O, and a decrease in
of subjects. The Control group included 300 normal, prevalence of hypertension by 4.3% in blood group A,
healthy subjects in the age group 20–70 years, males and 1.5% in blood group AB which was not statistically
and females, attending a general medicine outpatient significant (p>0.05). (Table-1).
department of Sri Guru Ramdas Institute of Medical The percentage distribution of Rh factor in the
Sciences and Research, Amritsar. The Study group control group showed 91% Rh+ve and 9% Rh-ve, while
comprised of 500 age-matched male and female hypertensive group showed 93.6% Rh+ve and 6.4% Rh
subjects having essential hypertension. -ve. The percentage distribution of Rh factor in total
Criteria for inclusion were blood pressure group of 800 subjects was found to be 92.62% Rh+ve
more than 140/90 mm Hg to be included in study group and 7.37% Rh-ve. There was increase in prevalence of
and below it to be included in control group. Subjects Rh+ve by 2.6% and decrease of Rh-ve by 2.6% in the
with diabetes mellitus and renal hypertension (serum hypertensive group which was statistically not
creatinine levels above 1.5 mg/dl) were not included in significant (p>0.05). (Table-2).
the study. The written and informed consent of the In Control group the genderwise percentage
subjects was obtained prior to collection of data. distribution of blood group A was more in males while
Conventional slide agglutination tests were the percentage distribution of blood group B, AB and O
done to determine the blood groups and Rh factor. The was increased in females. In hypertensive group the
blood pressure was recorded using mercury sphygmo- percentage distribution of blood group A, B, and O was
manometer by palpatory and auscultatory methods. increased in males and blood group AB was increased
Systolic and diastolic blood pressure of each subject was in females (Table-3). Blood groups in both genders do
recorded in the resting supine position. Three readings not vary significantly (p>0.05).
were recorded on each subject and their average was In the hypertensive group Rh+ve males were
taken as final record. Individuals with raised blood 93.48% and females were 93.72%, while Rh-ve males
pressure (BP) values of systolic blood pressure above were 6.51% and females were 6.27% respectively,
140 mmHg and diastolic blood pressure above 90 showing no significant variation in males and females
mmHg were classified as hypertensive. (p>0.05). Thus hypertension was not related to blood
Statistical analysis of data was done by group or gender. (Table-4).
applying Chi-square test to see any association of blood
Table-1: Frequency and distribution of ABO blood
groups and hypertension.
groups [n (%)]
RESULTS Blood group Control Hypertensive Total
A 73 (24.33) 100 (20) 173 (21.62)
This crosssectional study was conducted on 800 B 110 (36.66) 198 (39.6) 308 (38.5)
subjects, 406 males and 394 females, out of which 500 AB 22 (7.33) 29 (5.8) 41 (5.12)
(261 males and 239 females) were from hypertensives O 95 (31.66) 173 (34.6) 268 (33.5)
group and 300 (145 males and 155 females) were from Total 300 500 800
p=0.29
control group who were randomly selected from the
General Medical OPD. Table-2: Frequency and distribution of Rh factor
The percentage distribution of ABO blood [n(%)]
groups in the Control group of 300 normotensives Rh factor Control Hypertensive Total
showed predominance of blood group B (36.66%), Rh+ve 273 (91) 468 (93.6) 741 (92.6)
Rh-ve 27 (9) 32 (6.4) 59 (7.37)
followed by O (31.66%), A (24.33%), and AB (7.33%) Total 300 500 800
in both sexes. The same prevalence of blood groups (B, p=0.29
O and AB) was observed in Hypertensive group of 500
Table-3: Genderwise distribution of ABO blood groups [n (%)]
Blood Group Control Male Control Female Total Hypertensive Male Hypertensive Female Total
A 40 (54.79) 33 (45.20) 73 (24.33) 51 (51) 39 (39) 100 (20)
B 50 (45.45) 60 (54.54) 110 (36.6) 112 (56.56) 86 (43.43) 198 (39.6)
AB 10 (45.45) 12 (54.54) 22 (7.33) 13 (44.82) 16 (55.17) 29 (5.8)
O 45 (47.36) 50 (52.63) 95 (31.66) 92 (53.17) 8 (146.82) 173 (34.6)
Total 145 (48.3) 155 (51.66) 300 261 (52.2) 239 (47.8) 500
p-value p=0.45 p=0.41

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 Pak J Physiol 2016;12(2)

Table-4: Genderwise frequency and distribution of Rh factor [n (%)]

Rh factor Control Male Control Female Total Hypertensive Male Hypertensive Female Total
Rh+ve 132 (91.03) 141 (90.96) 273 (91) 244 (93.48) 224 (93.72) 468 (93.6)
Rh-ve 13 (8.96) 14 (9.03) 27 (9) 17 (6.51) 15 (6.27) 32 (6.4)
Total 145 (48.33) 155 (51.66) 300 261 (52.2) 239 (47.8) 500
p-value 0.45 0.94

DISCUSSION CONCLUSION & RECOMMENDATIONS

High blood pressure is a major public health problem in Blood group B is the most prevalent blood group in
India, rapidly increasing in urban and rural North Indian Punjabi populaton. The frequency of
populations.29,30 Majority of hypertensive subjects occurrence of hypertension was found to be highest in
remain undetected due to its initial asymptomatic blood group B and O, but it was statistically not
course, and thus its control is inadequate. This calls for significant. Certain precautions may be taken against
urgent prevention and control measures for hypertension in hypertension susceptible blood groups
hypertension.31 Studies suggest the genetic basis of right from their childhood in some specific blood group
essential hypertension in populations of different population. More studies to genetic level may be done
ethnicity.32,33 Thus, a non-modifiable factor like blood and anti-hypertensive medication engineered to help in
group can be used as a predictor for hypertension and its combating the consequences of hypertension.
awareness in the population can be used to initiate
lifestyle modifications in the susceptible category. ACKNOWLEDGEMENTS
In India, the ABO blood group frequency is We are thankful to the Director, Principal, and members
variable, the frequency of blood group B is 6% in of Ethical Committee for granting permission to conduct
Negritos of Andamans while it is 48% in Birijas of this study. We are also thankful to hospital staff and
Bihar. On the other hand blood group A is 20–30% in patients for their cooperation in data collection.
Western and Eastern Himalayas.34 The blood group
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Address for Correspondence:

Dr Manjeet Kaur, Associate Professor of Physiology, SGRDIMSAR, Amritsar, Punjab, India. Cell: +91-981-5311717
Email: [email protected]
Received: 21 May 2016 Revised: 18 Jun 2016 Accepted: 19 Jun 2016

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