Dose–response association between serum uric acid levels and incident hypertension: a systematic review and meta-analysis of 17 prospective cohort studies of 32 thousand participants

Abstract

Background Various magnitudes of the risk of incident hypertension (IHTN) have been reported to be associated with increased serum uric acid (SUA) levels in observational studies, however, whether a dose–response relation exists is unclear. We aimed to quantitatively evaluate the SUA–IHTN association. Methods We searched the PubMed and Embase databases for relevant articles published prior to 21 October 2019. Random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (CIs) of the IHTN risk in relation to SUA levels. We used restricted cubic splines to model the dose–response association between SUA levels and IHTN. Results A total of 17 articles (17 prospective cohort studies) including 321,716 adults and 65,890 IHTN cases were identified. The pooled RR was 1.10 (95% CI 1.07–1.13; I 2 =90.7%; n = 17) per 1 mg/dL change in the SUA level. In addition, we found evidence of a linear and positive dose–response association between SUA levels and IHTN (P non-linearity = 0.069). The results of the subgroup and sensitivity analyses were consistent with those of the primary analysis. Conclusion These data suggested that people with higher SUA levels had a higher IHTN risk. SUA levels need to be controlled to reduce or eliminate the risk of IHTN associated with SUA levels. Clinical trial studies or diagnostic studies are needed to determine the optimal cut-off point for SUA.