To Assess the Association Between Decreased Uric Acid Level and Blood Pressure

Abstract

Background: Asymptomatic hyperuricemia is commonly viewed as an entity that should not be treated. Treatment of asymptomatic hyperuricemia in patients with renal impairment is still in debate. There is no evidence to rationalize pharmacotherapy for patients with hyperuricemia with no complication and serum uric acid concentration is below 10 mg/dL. Objectives: To evaluate the association between decreased uric acid level and blood pressure. Methods: This was a single-center, single (patient blinded, placebo-controlled study conducted in chattogram medical college hospital over 1 year. Patients of both sexes aged above 18 years with eGFRs of 15 to 60 mL/ min/1.73 m2 (as calculated with the 4-variable MDRD) and serum uric acid levels ≥7 mg/dL were included. Patients were selected in purposive technique divided randomly by lottery into two groups. One group received febuxostat 40-mg tablet once daily and another group received placebo tablets at the same time. Both groups received antihypertensive and antidiabetic medication and diuretics as per needed. Drugs and placebo were continued throughout the study period. Patients were evaluated at baseline, 3rd and 6th months for history, physical examination, assessment of any adverse events or end points and relevant investigations. Results: 35 patients in each group were analyzed. Baseline characteristics were similar between the two groups. In febuxostat group the mean uric acid was decreased from 8.55 (±1.05) to 4.92 (±0.64) mg/dl, which was statistically significant (p <0.001) and in placebo group increased from 8.10 (±0.6) to 8.99 (±0.27) mg/dl which was statistically significant (P=0.001) after 6 months follow up. In case of mean eGFR in the febuxostat showed a nonsignificant increased from 25.28 (± 7.59) to 27.01 (±8.29) ml/min/1.73 m2, but in placebo group there was decreased mean eGFR from 26.81 (± 7.31) to 23.32(±7.72) ml/min/1.73 m2 which was statistically significant (p <0.001) and between group difference in eGFR was significant at 6 months (p = 0.048). Moreover after 6 months of treatment systolic and diastolic blood pressure were significantly lower in febuxostat group than placebo (p <0.05). Conclusion: Compared to placebo, febuxostat slowed the decline in eGFR in CKD stage 3 and 4