Uric Acid and Hypertension: An Update With Recommendations.

Content Provider	Europe PMC
Author	Sanchez-Lozada, Laura G Rodriguez-Iturbe, Bernardo Kelley, Eric E Nakagawa, Takahiko Madero, Magdalena Feig, Dan I Borghi, Claudio Piani, Federica Cara-Fuentes, Gabriel Bjornstad, Petter Lanaspa, Miguel A Johnson, Richard J
Copyright Year	2020
Abstract	Abstract The association between increased serum urate and hypertension has been a subject of intense controversy. Extracellular uric acid drives uric acid deposition in gout, kidney stones, and possibly vascular calcification. Mendelian randomization studies, however, indicate that serum urate is likely not the causal factor in hypertension although it does increase the risk for sudden cardiac death and diabetic vascular disease. Nevertheless, experimental evidence strongly suggests that an increase in intracellular urate is a key factor in the pathogenesis of primary hypertension. Pilot clinical trials show beneficial effect of lowering serum urate in hyperuricemic individuals who are young, hypertensive, and have preserved kidney function. Some evidence suggest that activation of the renin–angiotensin system (RAS) occurs in hyperuricemia and blocking the RAS may mimic the effects of xanthine oxidase inhibitors. A reduction in intracellular urate may be achieved by lowering serum urate concentration or by suppressing intracellular urate production with dietary measures that include reducing sugar, fructose, and salt intake. We suggest that these elements in the western diet may play a major role in the pathogenesis of primary hypertension. Studies are necessary to better define the interrelation between uric acid concentrations inside and outside the cell. In addition, large-scale clinical trials are needed to determine if extracellular and intracellular urate reduction can provide benefit hypertension and cardiometabolic disease.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7368167&blobtype=pdf
Page Count	13
ISSN	08957061
Volume Number	33
DOI	10.1093/ajh/hpaa044
PubMed Central reference number	PMC7368167
Issue Number	7
PubMed reference number	32179896
Journal	American Journal of Hypertension [Am J Hypertens]
e-ISSN	19417225
Language	English
Publisher	Oxford University Press
Publisher Date	2020-07-01
Publisher Place	US
Access Restriction	Open
Rights License	This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2020. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Subject Keyword	blood pressure fructose hypertension renin–angiotensin system uric acid xanthine oxidase
Content Type	Text
Resource Type	Article
Subject	Internal Medicine