Effect of hyperuricemia on the blood pressure response to antihypertensive agents in hospitalized elderly patients

Abstract

As elevated serum uric acid (SUA) is an independent risk factor for hypertension, we examined whether baseline SUA may influence the blood pressure (BP) response to antihypertensive medications. Data from 1648 inpatients with essential, uncontrolled hypertension on admission were analyzed retrospectively. Patients taking loop or thiazide diuretics or hypouricemic agents were excluded. The BP response to treatment was based on the BP change from admission (baseline) to discharge. The mean age was 66.7 ± 11.5 years, the average BP was 156.1/85.5 mmHg and the average estimated glomerular filtration rate (eGFR) was 80.07 ± 21.69 ml/min per 1.73 m. Twenty-five percent of the patients had chronic kidney disease and 32% had diabetes. The average duration of hospitalization was 14.3 ± 5.3 days. In 1149 patients with normal renal function (eGFR ≥60 ml/min per 1.73 m), those with hyperuricemia (SUA >420 μmol/l in men and >360 μmol/l in women) had more metabolic disorders (P < 0.05), higher baseline diastolic BP (P < 0.05), greater antihypertensive therapeutic intensity score (TIS) at baseline and discharge (P < 0.01), more diuretic use at discharge (P < 0.01) and less systolic BP reduction in response to antihypertensive therapy (P < 0.01). After adjustment for age, diabetes, BMI, baseline BP, lipid disorders, baseline TIS and eGFR, multiple linear regression using the data from all patients indicated that hyperuricemia was associated with a 5.3 mmHg less systolic BP reduction [95% confidence interval (CI): 3.1-7.4 mmHg, P < 0.01] in men, and a 2.6 mmHg less systolic BP reduction (95% CI: 0.5-4.6 mmHg, P = 0.02) in women. Hyperuricemia may be an independent risk factor for BP control in elderly hypertensive patients during hospitalization.