URIC ACID IN HYPERTENSION AND CARDIOVASCULAR DISEASE

Objective: Uric acid, a byproduct of purine metabolism, is linked to hypertension and cardiovascular diseases (CVD). Its role as a causal factor or marker remains debated. Recent studies confirm the role of uric acid in hypertension and cardiovascular diseases (CVD). For example, the PRIZE trial found that febuxostat reduced carotid intima-media thickness (CIMT) in patients withn hyperuricemia, although results on blood pressure (BP) reduction were inconsistent, A systematic review highlighted allopurinol’s potential to lower BP by reducing vascular resistance. Additionally, Mendelian randomization studies suggested that BP mediates a significant portion of uric acid’s impact on cardiovascular risk, underscoring its therapeutic importance.Design and method: We set out to evaluate the importance and respective results of the most recent studies on the topic.: - PRIZE study (2023) found that febuxostat reduced CIMT but showed mixed results for BP reduction, suggesting complex interactions. - Feig et ai. demonstrated allopurinollowered BP by reducing vascular resistance and plasma reninactivity - Mendelian Randomization studies indicate BP mediates about one-third of uric acid’s effect on cardiovascular risk, reinforcing its clinical significance in CVD prevention. This findings validated uric acid as a potential therapeutic target. Results: Studies reviewed mechanisms (oxidative stress, endothelial dysfunction) and trials on uric acid-lowering therapies (e.g. allopurinol). Elevated uric acid exacerbates hypertension and CVD risk. Reducing levels showed mixed results, benefiting selected groups: - Young individuals with early hypertension because studies sugests a stronger association between elevated uric acid and hypertension in younger patients, potentially due to fewer confounding metabolic factors, - Patients with hyperuricemia especialy those with gout or associated conditions like chronic kidney disease (CKD) where uric acid exacerbates systemic inflammation and oxidative stress. - High CVR groups with metabolic syndrome, diabetes, or resistant hypertension may benefit targeted interventions. Tailored therapy depends on individual comorbidities and baseline uric acid levels. Conclusions: Uric acid is modifiable risk factor, with therapy potential in tailored cases.