Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model

Abstract

Background: Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout. Objective: We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model. Method: A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting. Result: We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48–7.09) and an AOR of 4.44 (95% CI: 3.07 –6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02–0.08], p < 0.001). Conclusion: Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.

Immersion in Water Between 20-30oC Mediated Inflammations Marker to Reduced Pain Among Indonesian With Gout Arthritis: A Community-Based Randomized Controlled Trial

“…Hence, by considering hereditary characteristics and their interactions with environmental factors, these findings indicate that gout appears to be a serious public health issue in Indonesia (Kurniasari, et al, 2021b). This evidence shows that gout contributes to clinical impacts and highlights the necessity for more studies into effective gout therapy management (Kurniasari, et al, 2021a).…”

“…In the same circumstances, based on global racial comparisons, Indonesians have a higher gout risk due to the interplay between heredity and environmental factors which have led to high prevalence of hyperuricemia and gout in Indonesia (Kurniasari, et al, 2021b). Currently there are no guidelines for diagnosing and treating gout in Indonesia; consequently, general practitioners might treat gout patients differently (Kurniasari, et al, 2021a).…”

“…Characteristics of participants were assessed by applying a modified selfdesigned questionnaire which was validated in a previous study (Kurniasari, et al, 2021b;Tsai et al, 2007). We examined the body-mass index (BMI; Fabre et al, 2018;Kurniasari, et al, 2021a) and blood pressure (Cho et al, 2013;Kurniasari, et al, 2021b) in a physical examination. The location of gout inflammation was identified based on medical records in the CHS facilities of Tomohon City.…”

Hypertension and gout: A Mendelian randomization study

“…However, long-term use of diuretics may cause the human body to increase uric acid levels by increasing uric acid reabsorption and decreasing uric acid excretion, or by increasing the production of uric acid, thus inducing hyperuricemia, which in turn might potentially lead to the development of gout. However, some studies have also found that when adjusted for some variables, the positive association between hypertension and gout risk was not signi cant [32]. It should be noted that the inconsistent associations observed in these routine clinical studies are at least partially attributed to differences in sample size, reverse causality, and cultural, dietary, socioeconomic status, lifestyle, and genetic differences between populations at sampling sites that cannot fully mitigate confounding effects.…”

Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial

“…Likewise, a survey study among 4683 adults conducted in a rural area of Java Island, Indonesia, reported prevalences of gout and hyperuricemia in men of 1.7% and 24.3%, respectively. In a global ethnic group comparison, Malayo-Polynesian males had higher rates of gout and hyperuricemia than Caucasian men (Darmawan, 1992; Dyah Kurniasari et al, 2021). Another study also reported that gout is a common arthritic illness in Malayo-Polynesian people (Kurniasari et al, 2021; Padang et al, 2006), and Indonesians are included in the Malayo-Polynesian ethnic group (Klamer, 2019).…”