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The association between serum uric acid level and long-term incidence of hypertension: population-based cohort study

Abstract

Increasing experimental evidence, including recently developed animal models support a causal role for uric acid in the development of hypertension. However, it is not clear whether serum uric acid levels are independently associated with the long-term incidence of hypertension. We examined the association between serum uric acid levels and 10-year incidence of hypertension in a population-based cohort study based in Beaver Dam city and township, Wisconsin, US. We studied 2520 hypertension-free individuals (56.3% women, age: 43–84 years, 98% Caucasian) at the baseline examination (1988–1990). The main outcome of interest was hypertension (systolic blood pressure (BP) of 140 mm Hg or higher, diastolic BP 90 mm Hg or higher, or combination of self-reported high BP diagnosis and use of antihypertensive medications) incidence over 10 years among baseline normotensive individuals. Nine hundred and fifty-six individuals developed hypertension over a 10-year follow-up period. The relative risk (RR) (95% confidence intervals (CI)) of incident hypertension increased in a dose-dependent manner (P-trend<0.05 in all models) with increasing uric acid quartiles. Multivariable RR (95% CI) comparing the highest quartile of serum uric acid (390 μmol/l) to the lowest quartile (260 μmol/l) was 1.65 (1.41–1.93). This association persisted in subgroup analyses by categories of smoking, alcohol intake, body mass index, baseline blood pressure and estimated glomerular filtration rate (GFR). In conclusion, increasing quartiles of serum uric acid was associated with 10-year incidence of hypertension independent of smoking, alcohol intake and baseline kidney function suggesting an independent positive association between serum uric acid levels and hypertension development among community-dwelling older adults.

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Acknowledgements

This work was supported by National Institutes of Health grant EYO6594 (RK, BEK) and, in part, by Research to prevent Blindness (RK).

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Correspondence to A Shankar.

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Conflict of interest: There are no conflicts of interest related to this manuscript.

Guarantor statement: The guarantor, AS, accepts full responsibility for the work and/or the conduct of the study, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Contributors: All authors contributed to the intellectual development of this paper. AS had the original idea for the study, analysed the data, wrote the first draft paper, and is the guarantor. RK, BEKK, FJN provided statistical expertise, critical corrections to the manuscript and involved in manuscript revisions. RK, BEK procured funding for the study and supervised data collection.

Ethical approval: This study followed the recommendations of Declaration of Helsinki and was approved by the Human Subjects Committee of the University of Wisconsin Medical School, Madison, written informed consent was obtained from all participants.

Independence of researchers from funding source: The funding agencies had no role in the research presented in the paper including in the areas of design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript and the researchers were fully independent in pursuing this research.

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Shankar, A., Klein, R., Klein, B. et al. The association between serum uric acid level and long-term incidence of hypertension: population-based cohort study. J Hum Hypertens 20, 937–945 (2006). https://doi.org/10.1038/sj.jhh.1002095

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