Status of Uric Acid Management in Hypertensive Subjects

Abstract

Hyperuricemia in hypertensive subjects has been considered one of risk factors of cardiovascular diseases.We investigated the status of uric acid management in 799 hypertensive subjects (432 females and 367 males; mean age 70.9 years) managed by 43 doctors (19 cardiologists and 24 noncardiologists; 25 private practice doctors and 18 hospital doctors). The serum uric acid level was available in 85.7% of the patients.This availability was equivalent regardless of facility size, and more cardiologists than noncardiologists monitored this information. The prevalence of hyperuricemia was 17.5% and was higher in men and in patients with high triglyceridemia, left ventricular hypertrophy, renal dysfunction, proteinuria, and smokers, but was not higher in subjects with chronic heart failure, diabetes mellitus, and those with prescriptions for diuretics and -blockers. The average serum uric acid level was higher in men and patients with chronic heart failure, renal dysfunction, high triglyceridemia, low high-density cholesterolemia, smokers, and subjects prescribed -blockers. Fifty percent of hyperuricemic patients were medicated, and 48.6% of them cleared the uric acid target level (6 mg/dL). No differences were observed in the treatment rate or the achievement rate of the target between genders, concurrent diseases, and physician specialties. Although doctors, especially cardiologists, have a high concern for the serum uric acid level, they do not intervene intensively, and specific treatment for individual patterns is not routinely given. Thus, more attention to uric acid management is necessary in hypertensive subjects to prevent cardiovascular diseases. ( Hypertens Res 2007; 30: 549-554)

Effects of the N/L‐Type Calcium Channel Blocker Cilnidipine on Nephropathy and Uric Acid Metabolism in Hypertensive Patients With Chronic Kidney Disease (J‐CIRCLE Study)

“…Following the recent increase in complications associated with hypertension, such as the metabolic syndrome, close attention has been paid to the importance of hyperuricemia management when dealing with hypertensive patients with CKD . Patients with CKD are known to have a high incidence of complications associated with hyperuricemia, likely caused by reduced uric acid excretion via the tubule in the presence of compromised renal function (called renal hyperuricemia) or excessive production of uric acid as a result of stimulated production of a uric acid precursor hypoxanthine in the skeletal muscles under sympathetic hyperactivity (myogenic hyperuricemia) . The guidelines on hyperuricemia/gout treatment attach importance to BP control in drug therapy for hypertension and recommend the use of CCBs as antihypertensives because they have no adverse effects on uric acid metabolism …”

Increased Uric Acid Promotes Decline of the Renal Function in Hypertensive Patients: A 10-year Observational Study

“…Therefore, the therapeutic strategy should be determined after identifying the mechanism of hyperuricemia. Most hypertensive patients have been reported to have the decreased UA excretion type of hyperuricemia (31). Therefore, it is appropriate to administer benzbromarone, a uricosuric agent, rather than allopurinol, a xanthine oxidase inhibitor, in hypertensive patients with the decreased UA excretion type of hyperuricemia.…”

Analysis of Uric Acid Elevation

“…Moreover, uric acid itself also increases the arterial blood pressure (37). It has been shown in many studies that elevated uric acid levels are associated with hypertension (37,45,46). An increase of 1 mg/ dL in uric acid levels in the blood has been calculated to correspond to an increase of 20 mg/dL in cholesterol levels in terms of the increase in the risk of cardiovascular diseases (45).…”

“…It has been shown in many studies that elevated uric acid levels are associated with hypertension (37,45,46). An increase of 1 mg/ dL in uric acid levels in the blood has been calculated to correspond to an increase of 20 mg/dL in cholesterol levels in terms of the increase in the risk of cardiovascular diseases (45). However, although a positive relationship between hyperuricemia and hypertension was shown in several studies, Kalyon et al (37) failed to determine a correlation with blood pressure in patients with hyperuricemia.…”