Mild Hyperuricemia and Subclinical Renal Damage in Untreated Primary Hypertension

Viazzi, Francesca; Leoncini, Giovanna; Ratto, Elena; Falqui, Valeria; Parodi, Angelica; Conti, Novella; Derchi, Lorenzo E.; Tomolillo, Cinzia; Deferrari, Giacomo; Pontremoli, Roberto

doi:10.1016/j.amjhyper.2007.08.010

Cited by 49 publications

(42 citation statements)

References 31 publications

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“…In agreement with the literature, our study confirms that SUA concentrations are closely related to most components of the MetS [1e6, 16,19,20], including BMI or WC, triglycerides, HDL cholesterol and with the MetS itself, as well as with indices of renal function such as sCreat and estimated GFR [1e3, 6,7,15,21]. The association of SUA with these parameters, most of which are well known correlates of LVM, largely explained the significant univariate relationships that we found in female gender between SUA and cardiac hypertrophy.…”

Section: Discussionsupporting

confidence: 91%

“…Hyperuricemia is particularly common in hypertensive patients, especially in those with metabolic syndrome (MetS) [1e4], where may be a marker of hyperinsulinemia [5] and insulin resistance [5], as well as of renal dysfunction [1,3,6,7] and diuretic use [1,3]. In some, but not in all, studies [1,2,8] performed in hypertensive subjects, the association between serum uric acid (SUA) and cardiovascular (CV) events remained significant after adjustment for potential confounding factors.…”

Section: Introductionmentioning

confidence: 99%

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Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Mulè

Nardi

Costanzo

et al. 2013

Nutrition, Metabolism and Cardiovascular Diseases

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Background and aim: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results.The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. Methods and results: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained.In the overall population we observed no significant correlation of SUA with LV mass indexed for height 2.7 (LVMH 2.7 ) (r Z 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r Z 0.27; p < 0.001), but not in males (r Z À0.042; p Z NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH 2.7 was observed in the highest tertiles in women (44.5 AE 15.6 vs 47.5 AE 16 vs 55.9 AE 22.2 g/m 2.7 ; p < 0.001), but not in men.The association between SUA and LVMH 2.7 in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. Conclusions: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension. ª

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Mulè

Nardi

Costanzo

et al. 2013

Nutrition, Metabolism and Cardiovascular Diseases

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“…12 In addition, the ratio between renal volume and RRI (RV/RRI) was proposed as an integrated indicator of intrarenal arteriolopathy, as a reduction of RV and an increase in RRI occur in hypertensives as preclinical chronic ischemia ensues. 17 In our study, the association between hsCRP, RRI and RV/RRI in hypertensive patients with normal renal function and without MA, that is, without glomerular damage, is in line with the hypothesis of an early inflammatory involvement of renal interstitium in essential hypertension. In fact, tubules and interstitium, rather than glomerular capillaries, are considered to constitute the initial site of kidney injury, 25 and a common feature of experimental models of salt-sensitive hypertension is the existence of tubulo-interstitial inflammatory infiltration, in addition to intrarenal arteriolopathy.…”

Section: Discussionsupporting

confidence: 89%

“…We reported the preliminary results of a study that was aimed to evaluate the relationship between hsCRP, RRI and renal volume-to-resistive index ratio (RV/RRI), markers of tubulo-interstitial damage and intrarenal arteriolopathy, 17 in patients with WHO (World Health Organization) stage I-II essential hypertension, in chronic antihypertensive treatment, with preserved renal function and normal UAE.…”

Section: Introductionmentioning

confidence: 99%

Renal resistive index and low-grade inflammation in patients with essential hypertension

et al. 2011

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In essential hypertension, increased renal resistive index (RRI) is associated to a reduction of renal function and microalbuminuria, and to renal tubulo-interstitial damage. A tubulo-interstitial inflammatory infiltration was found in experimental models of hypertension, and serum high-sensitive C-reactive protein (hsCRP) levels correlated with urinary markers of tubulointerstitial damage in humans. We studied the relationship between RRI and serum hsCRP in hypertensives with preserved renal function, without microalbuminuria. We investigated hypertensive patients without diabetes, renal failure, microalbuminuria or major inflammatory disease. Serum levels of hsCRP were assayed. RRI was calculated by intrarenal Doppler ultrasound and considered pathologic when X0.70 or 495% of upper confidence limit expected for age decade. The renal volume-to-resistive index ratio (RV/RRI) was also calculated. We evaluated 85 patients (57 ± 14 years, 61 males). Patients with pathologic RRI (n ¼ 21) were older and had significantly higher hsCRP levels (4.70 ± 2.30 vs 2.93 ± 2.09 mg l À1 , Po0.01) compared with patients with normal RRI, as well as patients with decreased RV/RRI (n ¼ 43). HsCRP was directly related with RRI (r ¼ 0.41, Po0.001) and inversely with RV/RRI (r ¼ À0.35, Po0.001). HsCRP proved to be a significant predictor of both pathologic RRI and decreased RV/RRI, even after adjustment. In essential hypertension low-grade inflammation is associated with tubulo-interstitial damage evaluated by Doppler ultrasonography.

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“…15,35 Noteworthy, mild hyperuricemia was shown to be associated with renal damage in untreated primary hypertension. 36 All in all, we assume that the findings of the stratified spline analyses seem to be substantial from a public health viewpoint, because in the general adult population the prevalence of prehypertension and hypertension is approximately 60%, 37 and the prevalence of hyperuricemia (defined as UA Ͼ6.0 mg/dl in women and UA Ͼ7.0 mg/dl in men) is approximately 17%. 38 Future clinical trials might clarify whether lower UA treatment points should be entertained in this context.…”

Section: Discussionmentioning

confidence: 99%

Elevated Uric Acid Increases the Risk for Kidney Disease

Obermayr¹,

Temml²,

Gutjahr³

et al. 2008

Journal of the American Society of Nephrology

555

362

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Recent epidemiologic studies suggest that uric acid predicts the development of new-onset kidney disease, but it is unclear whether uric acid is an independent risk factor. In this study, data from 21,475 healthy volunteers who were followed prospectively for a median of 7 yr were analyzed to examine the association between uric acid level and incident kidney disease (estimated GFR [eGFR] Ͻ60 ml/min per 1.73 m 2 ). After adjustment for baseline eGFR, a slightly elevated uric acid level (7.0 to 8.9 mg/dl) was associated with a nearly doubled risk for incident kidney disease (odds ratio 1.74; 95% confidence interval 1.45 to 2.09), and an elevated uric acid (Ն9.0 mg/dl) was associated with a tripled risk (odds ratio 3.12; 95% confidence interval 2.29 to 4.25). These increases in risk remained significant even after adjustment for baseline eGFR, gender, age, antihypertensive drugs, and components of the metabolic syndrome (waist circumference, HDL cholesterol, blood glucose, triglycerides, and BP). In a fully adjusted spline model, the risk for incident kidney disease increased roughly linearly with uric acid level to a level of approximately 6 to 7 mg/dl in women and 7 to 8 mg/dl in men; above these levels, the associated risk increased rapidly. In conclusion, elevated levels of uric acid independently increase the risk for new-onset kidney disease.

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Mild Hyperuricemia and Subclinical Renal Damage in Untreated Primary Hypertension

Abstract: Mild hyperuricemia is associated with early signs of renal damage, ie, microalbuminuria and ultrasound-detectable abnormalities, regardless of the glomerular filtration rate in primary hypertension.

Cited by 49 publications

References 31 publications

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Renal resistive index and low-grade inflammation in patients with essential hypertension

Elevated Uric Acid Increases the Risk for Kidney Disease

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