Class effect of xanthine oxidase inhibitors on flow‐mediated dilatation in hypertensive patients: A randomized controlled trial

Abstract

A direct comparison of the effects of febuxostat and allopurinol on flow-mediated dilatation (FMD) will help to clarify which agent provides a better reduction of cardiovascular risk in hypertensive patients. Hypertensive patients with hyperuricemia were randomized into a febuxostat (10-40 mg, n = 33) or allopurinol (100-200 mg, n = 31) group and followed up for 6 months. Both the febuxostat (7.9 ± 1.3 mg/dL vs 5.6 ± 1.0 mg/dL, P < .001) and allopurinol (8.2 ± 1.3 mg/dL vs 6.1 ± 1.0 mg/dL, P < .001) groups exhibited significant reductions in uric acid after treatment. There was no significant difference in the change in FMD between the two treatment groups (0.6 ± 2.6% vs 0.2 ± 2.3%, P = .504). However, stratified analysis showed that febuxostat achieved a significantly greater change in FMD compared to allopurinol in the elderly group (1.3 ± 2.9% vs −0.7%±1.8%, P = .047). There was no difference in the improvement of FMD between febuxostat and allopurinol, but febuxostat may provide an improvement of FMD in elderly people.

Comparative effects of topiroxostat and febuxostat on arterial properties in hypertensive patients with hyperuricemia

“…17 FMD also improved during 8 weeks' treatment with topiroxostat in a retrospective cohort study of patients with hyperuricemia and cardiovascular risk, 18 and in a 12-week randomized controlled clinical trial that enrolled patients with hypertension and hyperuricemia. 20 In another meta-analysis, treatment with allopurinol significantly improved one measure of arterial stiffness (augmentation index) but not another (PWV). 25 In a study of cardiac surgery patients, PWV improved significantly from baseline during 6 months of treatment with febuxostat, but not allopurinol.…”

“…17 FMD also improved during 8 weeks' treatment with topiroxostat in a retrospective cohort study of patients with hyperuricemia and cardiovascular risk, 18 and in a 12-week randomized controlled clinical trial that enrolled patients with hypertension and hyperuricemia. 20 In another meta-analysis, treatment…”

“…Data from a systematic review and meta‐analysis of randomized controlled trials of allopurinol found that treatment was associated with a significant increase in flow‐mediated diameter (FMD, as a measure of endothelial function) 17 . FMD also improved during 8 weeks' treatment with topiroxostat in a retrospective cohort study of patients with hyperuricemia and cardiovascular risk, 18 and in a 12‐week randomized controlled clinical trial that enrolled patients with hypertension and hyperuricemia 20 . In another meta‐analysis, treatment with allopurinol significantly improved one measure of arterial stiffness (augmentation index) but not another (PWV) 25 .…”

“…15,16 Data on the effects of XORi on arterial properties, including flow-mediated dilatation (FMD) and pulse wave velocity (PWV), are also inconsistent. Some studies have shown benefit [17][18][19][20] and others no effect. 21 It is possible that effects may differ between agents in this class, but there is a relative lack of published data on the effects of topiroxostat on arterial properties.…”

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

“…The HOPE Asia Network has published a number of papers on important Asia‐specific topics in hypertension . This Asia‐specific issue of the Journal of Clinical Hypertension provides an important resource including original research and review articles on the management of hypertension from a variety of Asian viewpoints, including topics such as central BP, environmental factors, comorbidities such as diabetes, atrial fibrillation, heart failure, and dementia, recent Asian guidelines and so forth . This issue also includes reports from twelve countries/regions in Asia to help define and highlight the current status of hypertension, its management, and their initiatives.…”