Uric Acid and the Development of Hypertension

Abstract

Abstract-Experimental evidence supports a causative role for uric acid in the pathogenesis of hypertension. Prospective studies have variably adjusted for relevant confounders and have been of relatively limited duration. We prospectively examined the relationship between uric acid level and the development of hypertension in the Normative Aging Study, a longitudinal cohort of healthy adult men. Key Words: uric acid Ⅲ hypertension Ⅲ renal function Ⅲ prospective studies Ⅲ aging T he association of hyperuricemia with hypertension has long been recognized. 1 It remains unresolved whether the association of hyperuricemia with hypertension is solely because of underlying renal and metabolic abnormalities. Decreased renal blood flow 2 and decreased tubular secretion of uric acid 3 have been associated with hyperuricemia in hypertension. Hyperinsulinemia secondary to insulin resistance may also contribute to the association of hyperuricemia with hypertension. 4,5 Recent observations in experimental hyperuricemia suggest that uric acid may in fact have a pathogenic role in hypertension. 6 Hyperuricemia induces hypertension in experimental animals that corrects with hypouricemic therapy. 7 Elevated serum uric acid level has been associated with increased risk for developing hypertension. 8 -18 The Normative Aging Study (NAS), a longitudinal study of aging begun in 1963 and with ongoing follow-up, presented a unique opportunity to examine the relationship between serum uric acid level and the development of hypertension. The duration of follow-up, Յ40 years, allowed us to assess the durability of the prospective association of uric acid level with hypertension. The comprehensive data collection allowed adjustment for key potential confounding covariates, such as central adiposity, alcohol intake, metabolic parameters, and, in a subset of study subjects, the serum creatinine level. Previous studies have variably accounted for these confounders. Specifically, some did not adjust for blood pressure, 8,9,17,18 Ն2 elements of the metabolic syndrome, 8 -11,13-15 or alcohol intake, 11,12 and only 1 adjusted for renal function. 13 We, therefore, examined the prospective association of serum uric acid level with the development of hypertension among subjects at risk for the development of hypertension within the NAS cohort, including an analysis of those at risk for the development of hypertension at the time of their first serum creatinine determination. We have included in our multivariable model(s) covariates of the metabolic syndrome, alcohol intake, and renal function. MethodsSubjects were participants in the NAS, a longitudinal study of aging established by the Veterans Administration in 1961. 19 The study cohort consists of 2280 community-dwelling men from the greater Boston area who were 21 to 80 years of age on enrollment. Volunteers were screened at entry according to specific health criteria and were free of known chronic medical conditions at the

Prediction models for the risk of new-onset hypertension in ethnic Chinese in Taiwan

“…40 Among the 2062 men free of hypertension in the Normative Aging Study for a 21-year follow-up period, uric acid increased newonset hypertension risk by 1.05-fold, 40 similar to our estimate in the multivariate model. We believe that most of the variables included in our models were feasible in the usual care practice in primary prevention settings.…”

Associations between serum uric acid levels and the incidence of hypertension and metabolic syndrome: a 4-year follow-up study of a large screened cohort in Okinawa, Japan

“…MetS is characterized by the presence of multiple common cardiovascular risk factors, such as central obesity, atherogenic dyslipidemia (hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C)) levels, hyperglycemia and elevated blood pressure (BP). Elevated SUA levels are prevalent in patients with hypertension 1,2 and MetS, [3][4][5][6][7] and these levels can be a significant predictor of the development of hypertension 3,[8][9][10] and MetS. [11][12][13][14] Although evidence has suggested that elevated SUA levels might have a role in hypertension, 15 a causal relationship has not been established.…”

Associação entre ácido úrico e variáveis de risco cardiovascular em uma população não hospitalar

“…Studies are necessary to understand the actual role they have in this scenario and whether they can actually be of value in the early identification of individuals at risk of developing CVD. Among these studies, is the one on uric acid (UA), which has behaved as a cardiovascular risk factor in several cross-sectional studies [1][2][3][4][5] . However, the presence of several confounding variables, such as obesity, alcohol consumption, age, diabetes and use of diuretics have made it difficult, to date, to indisputably practice, especially in individuals with metabolic syndrome and arterial hypertension.…”