Uric Acid Levels Linked to Negative Cardiovascular Outcomes in Hypertensive Patients

Uric acid levels might help forecast the risk of severe cardiovascular outcomes, including death, in hypertensive patients.

A team, led by Yong Yang, Department of Cardiology, The Third Medical Center of PLA General Hospital, evaluated the prognostic utility of uric acid in hypertensive patients.

Much of the research regarding the association of uric acid with mortality and cardiovascular outcomes in patients with hypertension have been contradictory.

Literature Search

The researchers searched various databases to identify studies reporting on the association of uric acid with mortality and cardiovascular outcomes in patients with hypertension.

The researchers sought outcomes including cardiovascular or all-cause mortality, coronary artery disease (CAD), stroke, and major adverse cardiovascular events (MACEs).

Overall, they identified 11 eligible studies involving 49,800 hypertensive patients.

Hazard Ratios

The pooled hazard ratio (HR) was 1.51 (95% CI, 1.12-2.02) for all-cause mortality for patients with the highest than those with reference lower group of uric acid level. The HR for this patient population was also 1.68 (95% CI, 1.28–2.20) for cardiovascular mortality, 1.31 (95% CI, 1.10–1.55) for CAD, and 1.48 (95% CI, 1.28–1.70) for MACEs.

There was no significant association between elevated uric acid level and incident stroke in this patient population.

“This meta-analysis indicates that elevated uric acid level is significantly associated with an increased risk of cardiovascular or all-cause mortality, CAD and MACEs in hypertensive patients,” the authors wrote. “Hypertensive patients with highest uric acid level exhibited a tendency for reduced risk of stroke, but the difference is not significant.”

Treatment Options

Recently, researchers found the combination of a polypill comprising statins, multiple blood-pressure-lowering drugs, and aspiring could reduce the overall risk of developing cardiovascular disease.

Overall, the low-density lipoprotein cholesterol level was lower by approximately 19 mg per deciliter and systolic blood pressure was lower by approximately 5.8 mm Hg with the polypill and with combination therapy than with placebo.

The investigators sought primary outcomes for the polypill-alone and polypill-plus aspirin arms of the study was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization.

They also sought primary outcomes for the aspirin comparison of death from cardiovascular causes, myocardial infarction, or stroke.

The investigators found the primary outcome for the polypill comparison occurred in 126 participants (4.4%) in the polypill group and in 157 (5.5%) in the placebo group (HR, 0.79; 95% CI, 0.63-1.00).

For the aspirin group, the primary outcome occurred in 116 participants (4.1%) in the aspirin group and in 134 (4.7%) in the placebo group (HR, 0.86; 95% CI, 0.67-1.10).

For the polypill-plus aspirin combination, the primary outcome occurred in 59 individuals (4.1%) in the treatment group and in 83 (5.8%) individuals in the double-placebo group (HR, 0.69; 95% CI, 0.50-0.97).

The study, “Association of serum uric acid with mortality and cardiovascular outcomes in patients with hypertension: a meta-analysis,” was published online in the Journal of Thrombosis and Thrombolysis.