Effects of uric acid-lowering therapy in patients with essential arterial hypertension

Abstract

BackgroundAsymptomatic hyperuricemia (AHU) is de ned as elevated serum uric acid (UA) concentration without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). MethodsPatients aged 30-70 years with AHU and essential hypertension grade 1-2 with adequate blood pressure (BP) control, without previous urate lowering therapy (ULT) were divided into two groups: a) receiving allopurinol (ULT group) and b) age-and sex matched patients without ULT (control group). Both groups received UA-lowering diet. BP (o ce, 24 hour and central), echocardiographic parameters, pulse-wave velocity, carotid intima-media thickness (IMT) and lab tests (high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and at 6 months follow-up. ResultsOut of 100 participants 87 completed the study (44 ULT patients and 43 controls). At 6 months follow-up, there was a signi cantly greater reduction in serum UA concentration in the ULT group than in the control group (464±68.8 µmol/l vs 314±55.6 µmol/l, p<0.0001). Patients receiving allopurinol had signi cant reductions in o ce systolic (137±11.8 mmHg vs 134±9.3 mmHg; p=0.025) and diastolic BP (83±9.9 mmHg vs 79±8.7 mmHg, p=0.017), central systolic BP (56±8.9 mmHg vs 51±12.9 mmHg, p=0.046), pulse pressure (43±10.4 mmHg vs 39±11.2 mmHg, p=0.017), IMT (0.773±0.121 mm vs 0.752±0.13 mm, p=0.044), left atrium volume index (40±13.5 ml/m 2 vs 38±12.3 ml/m 2 , p=0.044), and hs-CRP level (3.36±2.73 mg/l vs 2.74±1.91 mg/l, p=0.028) compared to controls. The decrease in UA concentration was signi cantly related to the reduction in IMT (R=0.37, p<0.001), central SBP (R=0.26, p=0.015) and hs-CRP concentration (R=0.30, p=0.004). Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (R=0.3234, R2=0.0722, p<0.026). ConclusionsIn patients with AH and asymptomatic hyperuricemia treatment with allopurinol leads to further improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a bene cial effect on patient long-term prognosis. BackgroundAsymptomatic hyperuricemia (AHU) is traditionally de ned as elevated serum uric acid (UA) concentration but in which neither symptoms of monosodium urate crystal deposition disease, such as gout, nor uric acid renal disease have occurred [1]. The prevalence of AHU has increased over several

Uric Acid and Oxidative Stress—Relationship with Cardiovascular, Metabolic, and Renal Impairment

“…The incriminated pathways are activation of epithelial- and endothelial-to-mesenchymal transition (EMT, EndoMT), which will activate fibroblasts and myofibroblasts and subsequent renal fibrosis [ 25 ]. Other studies associate inflammation markers, such as C-reactive protein (CRP) or TNF-alfa, as directly proportional with serum UA concentrations [ 61 , 62 ]. Some researchers consider that serum UA can be a strong predictor of acute kidney injury without correlation with the baseline renal function [ 63 ].…”

Association between Cardiovascular Health, C-Reactive Protein, and Comorbidities in Spanish Urban-Dwelling Overweight/Obese Hypertensive Patients

“…Taken together, therefore, a linking mechanism between Ow/Ob-associated CRP levels and HMOD-HRC in hypertensive patients seems likely. The fact that reduction in inflammation, evaluated by CRP levels, has been associated with a reduction in HMOD with uric-acid-lowering therapy in patients with essential hypertension [35] supports this hypothesis. Further large prospective intervention studies are needed to demonstrate that advocating ideal CVHM may decrease hs-CRP, leading to prevention of hypertension-related complications.…”

Association between hyperuricemia and long-term mortality in patients with hypertension: results from the NHANES 2001–2018

“…A cohort study involving 100 participants with asymptomatic hyperuricemia revealed that, compared with HCs, those receiving allopurinol experienced significant reductions in office systolic and diastolic blood pressure, central systolic blood pressure, pulse pressure, carotid intima-media thickness, and hs-CRP. These improvements are indicative of a positive impact on a patient's long-term prognosis ( 34 ). Furthermore, a meta-analysis of seven eligible trials involving 503 participants with hyperuricemia demonstrated that urate-lowering therapy led to decreases in systolic and diastolic blood pressure, fasting insulin levels, and homeostasis model assessment of insulin resistance ( 35 ).…”