A multicenter study of the association of serum uric acid, serum creatinine, and diuretic use in hypertensive patients

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Abstract

Background

Individuals with hypertension and hyperuricemia have an increased risk of coronary artery disease and cerebral vascular disease as compared to patients with normal uric acid levels. Our aim is to determine the prevalence of hyperuricemia in hypertensive patients in Taiwan, and whether serum uric acid (SUA) is associated with changes in renal function in patients with hypertension.

Methods

We studied 2145 hypertensive patients receiving medical treatment, assessed the prevalence of hyperuricemia, and determined the independent risk factors for SUA. Simple correlation and multiple regression analyses were applied to identify the independent risk factors for SUA increase. Logistic regression analysis was used to estimate the association between 4 quartiles of SUA level and correspondent serum creatinine (SCr) concentrations.

Results

Hypertensive subjects had a high prevalence of hyperuricemia (men, 35%; women, 43%). SUA was significantly associated with the independent risk factors of SCr, diuretic usage, and diabetes (inversely related) in both genders, whereas β-blocker usage and body mass index were only associated in men. Multiple logistic regression models showed that in the non-diuretic user group the highest SUA quartile entailed > 4 times greater risk for SCr elevation than the lowest. In the diuretic user group, a > 2 times greater risk was noted.

Conclusions

Hyperuricemia hypertensive subjects demonstrated a corresponding elevation of SUA and SCr irrespective of diuretic use. Elevation of SUA, in addition to SCr, may represent a progression of renal function impairment.

Introduction

Over the past decade, studies have shown that patients with hypertension and hyperuricemia have a 3- to 5-fold increased risk of coronary artery disease and cerebral vascular disease as compared to patients with normal uric acid levels [1], [2]. In experimentally induced hyperuricemia, the development of pre-glomerular arteriolar lesions has been shown to result in reduced renal blood flow, glomerular hypertension and glomerulosclerosis [3]. It is also known that antihypertensive drugs impact the serum uric acid (SUA) level and patient outcomes [4], [5], [6]. The prevalence of hyperuricemia in hypertensive patients in Taiwan is not known and whether high SUA and antihypertensive treatment impacts renal function is still unanswered. Therefore, we conducted a hospital based study to investigate a group of hypertensive patients treated at outpatient clinics in Taiwan and to determine if SUA level is independently associated with serum creatinine (SCr), hypertensive treatment regimens, and specific demographic or disease characteristics.

Section snippets

Study hospitals

We divided Taiwan into 4 areas, north, center, south, and east coast based on geographical characteristics and urbanization index. The population of Taiwan is approximately 23 million, and northern Taiwan is the most developed and the east coast area is the least developed.

Investigating hospitals located in either metropolitan or provincial cities in these 4 areas were selected according to population density. Nine hospitals in the north area, 4 hospitals in the center area, 4 hospitals in the

Results

A total of 2187 patients were recruited and 42 patients (1.9%) were excluded due to insufficient information of SUA (9), prescription drug use (25), and missing questionnaire data (8). Thus, 2145 patients (1139 men, 1006 women) were included in the statistic analysis. We found the prevalence of hyperuricemia (average in men 35%; average in women 43%) was considerably higher in hypertension subjects: 33% in adult men, 32% in old men, and 34% in elderly men, 41% in adult women, 41% in old women,

Discussion

This study revealed that hypertensive subjects had a high prevalence of hyperuricemia. SCr and diuretic usage were independently and significantly associated with SUA. Subjects on diuretic therapy had significantly elevated SUA and SCr levels in comparison to non-diuretic users. After being stratified SUA into 4 quartiles, SUA values were found to be significantly correlated with SCr elevation. In comparison to the lowest quartile of SUA, the higher quartile of SUA had a significantly greater

Conflict of interest

Dr. Chung-Sheng Lin received research grants from Merck and Pfizer. He is serving as a consultant to Pfizer and Takeda. He has received lecture fees from Merck, Pfizer, Novartis, Servier, Astra-Zeneca, Takeda, and Bayer.

Acknowledgements

This study was supported by Merck Co., Taiwan.

The authors thank Ya-Chuan Wang and Vivien Chien for their assistance with the statistics analysis and data collection.

Co-investigators: Kuei-Feng Chen, Yin-Cheng Chen, Ching-Li Lin, Pan-Chen Chang, I-Chung Chen, Zheng-Wei Chu, Chi-Hsiang Chou, Chih-Ming Chen, Chyunshin Fannjiang, Ping-Yi Liu, Shin-Chieh Chang, Cheng-Ta Chung, Yung-Hua Chu, Wen-Che Chi, and Wen-Wei Chen.

The authors of this manuscript have certified that they comply with the

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