Serum uric acid and arterial hypertension—Data from Sephar III survey

Abstract

ObjectivesThis paper aims to evaluate the association between serum uric acid (SUA) levels, arterial hypertension (HT) prevalence, blood pressure values control, kidney function and intima media thickness (IMT), as a surrogate marker of early atherosclerosis, in a representative group of Romanian adult population.Materials and methodsThe study sample consists in 1920 adults included in SEPHAR III (Study for the Evaluation of Prevalence of Hypertension and cArdiovascular Risk in Romania) survey (mean age 48.63 years, 52.76% females) collecting data for SUA levels, blood pressure (BP) measurements, kidney function by estimated glomerular filtration rate (eGFR) and carotid IMT. SUA levels between 2,40–5,70mg/dl in females and 3,40–7,00mg/dl in males respectively were considered normal. HT and HT control were defined according to the current guidelines. IMT evaluation was assessed by B-mode Doppler ultrasound evaluation.ResultsHypertensive subjects had significantly higher values of SUA compared with normotensive subjects, hypertensive patients were 1.713 times more likely to have higher values of SUA. Among treated hypertensive patients, those without optimal BP control had significantly higher SUA levels compared with those with optimal BP control, the presence of hyperuricemia increasing the odds of suboptimal BP control by 1.023. Hyperuricemic subjects had significantly lower eGFR values compared with normouricemic ones, on an average with 14.28ml/min/1.73m2 by Modification of Diet in Renal Disease formula (MDRD) and with 16.64ml/min/1.73m2 by Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI), with an indirect association between SUA levels and eGFR values (rs = -0.319 / -0.347), independent of age. IMT values recorded in hyperuricemic subjects were significantly increased, on an average with 0.08mm, compared with normouricemic subjects, with a direct association between SUA levels and IMT values (rs = 0.263), independent of BP values.ConclusionThe results of our study offers support that increased SUA levels are associated with arterial hypertension and with suboptimal BP control in treated hypertensive subjects. The decline in kidney function, independent of age, and also increased IMT values as a marker of atherosclerosis, were also correlated with elevated SUA values. Hyperuricemia screening may have a role in identifying patients at risk of developing HT and lowering SUA levels may improve not only BP control in treated HT patients but also decrease total cardiovascular mortality by slowing the progression of atherosclerosis and renal failure in hypertensive patients.

Role of Serum Uric Acid in the Assessment of Stroke

“…[6] The SUA concentration in adult women, which were lower than in men of a similar age, it could be related to a higher renal clearance of uric acid in women, possibly due to higher oestrogen levels in their plasma. [10] In this study significant relation was observed between uric acid and hypertension this results was consistent with a study conducted with 297 individuals from Cameroon population, [11] in study with 163 individuals more than 70 years of age admitted in hospital due to a first time ever acute ischemic/ non-embolic stroke and 166 volunteers without a history of cardiovascular disease in Greece, [6] study with 1920 adults from Romanian adult population, [12] and also a cohort study from china with 1082 healthy participants aged 41 to 70 years. [13] A meta-analysis and systematic review concluded that 1.0 mg/dl increase in SUA level is associated with an increased risk of incident hypertension by 13%.…”

Hyperuricemia, the heart, and the kidneys – to treat or not to treat?

“…Higher values of SUA and body mass index have been associated with eGFR decline of 50% or end-stage kidney disease in patients with arterial/arteriolar nephrosclerosis [76]. Furthermore, increased SUA correlates with increased intima media thickness values as markers of atherosclerosis and suboptimal blood pressure control [77]. Contrarily, some researchers have shown that hyperuricemia and higher SUA were associated with lower risk of all-cause and CV mortality in the hemodialysis population [78,79].…”

Serum uric acid as a prognostic indicator in acute ischemic stroke

“…Buzas R et al, reported that increased SUA levels are associated with arterial hypertension and with suboptimal BP control in treated hypertensive subjects. 16 In this study, 18 patients were obese BMI >25 (43%). These patients had elevated uric acid levels.…”