Abstract-The question of serum uric acid as an independent risk factor in subjects with essential hypertension remains controversial. For up to 12 years (mean, 4.0) we followed 1720 subjects with essential hypertension. At entry, all subjects were untreated and all were carefully screened for absence of cardiovascular disease, renal disease, cancer, and other important disease. Outcome measures included total cardiovascular events, fatal cardiovascular events, and all-cause mortality. Key Words: uric acid Ⅲ blood pressure Ⅲ cardiovascular disease Ⅲ hypertension, essential Ⅲ blood pressure monitoring Ⅲ hypertrophy, left ventricular S everal cohort studies conducted over the past 5 decades showed a link between serum uric acid (SUA) and subsequent cardiovascular (CV) disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, in some of these studies such association did not remain significant after adjustment for concomitant risk factors for CV disease 2,4,5,12,15 or it was detected only in women. 6,8,10 Thus, the role of SUA as an independent risk marker remains controversial. 16 An increase in SUA might be simply a marker of obesity, hyperinsulinemia and glucose intolerance, 17,18 hypertension, 5 hyperlipidemia 19 and renal disease. 20,21 The assessment of the independent prognostic value of SUA is clinically relevant in the specific setting of essential hypertension, in which hyperuricemia is frequent 22 and cardiovascular risk stratification is of utmost importance. In a recent cohort study in subjects with hypertension, 14 the association between SUA and future CV events remained significant after adjustment for concomitant diuretic therapy, previous CV events, and other risk factors including office blood pressure (BP). In contrast, pretreatment SUA was not an independent predictor of CV events in the setting of the European Working Party on High Blood Pressure in the Elderly trial. 23 Because of the discrepancy between these findings, we analyzed the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) database to clarify the independent prognostic value of SUA in a large cohort of initially untreated and apparently healthy subjects with essential hypertension.
Methods
PIUMA StudyThe design of the PIUMA study has been reported previously. 24,25 Office BP had to be Ն140 mm Hg systolic and/or Ն90 mm Hg diastolic on Ն3 visits, and all of the subjects fulfilled the following inclusion criteria: no previous antihypertensive treatment or treat-