Degree Of Blood Pressure Control And The Risk Of New-Onset Hyperuricemia Among Hypertensive Population In China

Objective: We aimed to investigate the relationship of blood pressure(BP)control with uric acid(UA)change and new-onset hyperuricemia(HUA)among hypertension patients in Lianyungang City.Methods: A prospective follow-up study was conducted from May 19,2008 to August24,2013 among hypertensive population in donghai county and ganyu county in Lianyungang City,Jiangsu Province.Participants were randomly assigned to receive a daily treatment of a fixed combination of enalapril 10 mg and folic acid 0.8mg(enalapril folic acid tablets)or enalapril 10 mg alone.BP measurements were taken every 3months after randomization.Blood samples of all participants were collected at both the baseline and the exit visits.Characteristics of study participants were collected using epidemiological questionnaires.Serum uric acid concentration was measured using automated analyzer(Beckman Coulter,USA).The primary outcome was new-onset hyperuricemia,defined as participants with normal UA concentrations(<357μmol/L[6mg/dL])at baseline and with a UA concentration ≥357μmol/L(6mg/dL)in women or≥417μmol/L(7mg/dL)in men at the exit visit.The secondary outcome was change in UA concentrations,defined as UA concentrations at the exit visit minus that at baseline.Multivariable logistic regression models and generalized linear regression models were used to examine the relationship of time-average on-treatment BP with new-onset hyperuricemia and change in UA,respectively.Results: A total of 10,617 hypertensive patients were included from the UA Sub-study.Over a median follow-up of 4.4 years,1664(15.7% hypertensive participants developed new-onset hyperuricemia.Overall,there was a significantly positive association between time-averaged on-treatment diastolic BP(DBP)and new-onset hyperuricemia(per 10 mm Hg increment;OR,1.13;95%CI : 1.02–1.26;P=0.021).Consistently,a significantly higher risk of new-onset hyperuricemia was found in participants with time-averaged on-treatment DBP ≥82.9mm Hg(median)(vs.<82.9mm Hg;17.3% versus14.1%;OR,1.25;95%CI: 1.10–1.44;P<0.001).Furthermore,in the stratified analysis,a positive association was observed between time-averaged on-treatment DBP(median,<82.9 versus ≥82.9mm Hg)and new-onset hyperuricemia among participants with lower time-averaged on-treatment SBP(median: <138.3;OR,1.48;95%CI: 1.23–1.78;vs.≥138.3mm Hg;OR,1.13;95%CI: 0.94–1.35;P-interaction=0.023).The lowest new-onset hyperuricemia risk(12.1%)was found in those with both lower DBP and lower SBP levels.The results were similar for time-averaged DBP during the first12-month or 24-month treatment period,or in the analysis using propensity scores.However,there was no significant association between time-averaged on-treatment SBP and new-onset hyperuricemia.Notably,a non-significant higher risk of new-onset hyperuricemia was observed in participants with time-averaged on-treatment SBP≥120mm Hg(vs.<120mm Hg;OR,1.61;95%CI: 0.88–2.97;P=0.125).Conclusions: A tight DBP control of <82.9mm Hg was associated with lower risk of new-onset hyperuricemia among hypertensive patients without hyperuricemia.Of note,in the stratified analysis,the lowest new-onset hyperuricemia risk was found in those with both lower DBP and lower SBP levels.These results suggested that a relatively stricter both SBP and DBP control may lead to a greater reduction of new-onset hyperuricemia in general hypertensive patients.