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Update in uric acid, hypertension, and cardiovascular diseases

  • Review Article
  • Current topic in Hypertension
  • Published:
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Abstract

A direct relationship between serum uric acid levels and hypertension, cardiovascular, renal and metabolic diseases has been reported in many basic and epidemiological studies. Among these, high blood pression is one of the most common features associated with hyperuricemia. In this regard, several small-scale interventional studies have demonstrated a significant reduction in blood pressure in hypertensive or prehypertensive patients on uric acid-lowering drugs. These observation or intervention studies have led to affirm that there is a causal relationship between uric acid and hypertension. While the clinical association between uric acid and high blood pressure is notable, no clear conclusion has yet been reached as to whether lowering uric acid is beneficial to prevent cardiovascular and renal metabolic diseases. Recently, several prospective randomized controlled intervention trials using allopurinol and other uric acid-lowering drugs have been reported, and the results from these trials were almost negative, suggesting that the correlation between hyperuricemia and cardiovascular disease has no causality. However, it is important to note that in some of these recent studies there were high dropout rates and an important fraction of participants were not hyperuricemic. Therefore, we should carry caution in interpreting the results of these studies. This review article presents the results of recent clinical trials using uric acid-lowering drugs, focusing on hypertension and cardiovascular and renal metabolic diseases, and discusses the future of uric acid therapy.

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Acknowledgements

We thank Richard Johnson (Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, CO, USA) for his advice of this review article.

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Authors and Affiliations

  1. Department of Cardiology, Toranomon Hospital, Tokyo, Japan

    Masanari Kuwabara & Takahide Kodama

  2. Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan

    Ryusuke Ae

  3. Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey

    Mehmet Kanbay

  4. Division of Endocrinology, Metabolism and Diabetes, School of Medicine, University of Colorado Denver, Aurora, CO, USA

    Ana Andres-Hernando & Miguel A. Lanaspa

  5. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Claudio Borghi

  6. Department of Cardiology, Yonago Medical Center, Yonago, Torrori, Japan

    Ichiro Hisatome

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Dr Kuwabara reports a research grant from JSPS KAKENHI (Grant Number 20K17168 and 23K07493), Okinaka Memorial Institute for Medical Research, and Toranomon Hospital. The remaining authors have nothing to disclose.

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Kuwabara, M., Kodama, T., Ae, R. et al. Update in uric acid, hypertension, and cardiovascular diseases. Hypertens Res 46, 1714–1726 (2023). https://doi.org/10.1038/s41440-023-01273-3

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