High serum uric acid within the normal range is a useful predictor of hypertension among Japanese community-dwelling eld
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RESEARCH
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High serum uric acid within the normal range is a useful predictor of hypertension among Japanese community-dwelling elderly women Ryuichi Kawamoto1,2* , Daisuke Ninomiya1,2, Taichi Akase1,2, Kikuchi Asuka1,2 and Teru Kumagi1
Abstract Background: The risk associated with serum uric acid (SUA) levels when within the normal range is unknown. This study aims to examine whether SUA within the normal range is a predictor of hypertension. Methods: The subjects comprised 704 men aged 71 ± 9 (mean ± standard deviation) years and 946 women aged 70 ± 8 years recruited for a survey at the community based annual medical check-up. The main outcome was the presence of hypertension (antihypertensive medication and/or having SBP ≥140 mmHg and/or DBP ≥90 mmHg). Results: At baseline, 467 (66.3%) men and 608 (64.3%) women had hypertension. Comparing to lowest quartile in women (SUA-1, uric acid < 4.1 mg/dL), the unadjusted odds ratios (ORs) [95% confidence interval (CI)] for hypertension of SUA-2 (4.1 to 4.7 mg/dL), SUA-3 (4.8 to 5.4 mg/dL), and SUA-4 (≥5.5 mg/dL) were 1.11 (0.78–1.59), 1.75 (1.20–2.55), and 1.89 (1.30–2.77), respectively. These associations were apparent even after adjustments for age, but ORs were attenuated after adjusting for all confounding factors. During a follow-up of 3.0 years, there were 35 (24.0%) hypertension cases in men and 51 (20.8%) in women. In women only, a significant association between increased SUA categories and incidence of hypertension was observed, and the multivariate-ORs (95% (CI) for incident hypertension of SUA-3 (4.5–5.2 mg/dL) and SUA-4 (≥5.3 mg/dL) were 2.23 (0.81–6.11) and 3.84 (1.36–10.8), respectively. Conclusions: These results suggest that baseline SUA within the normal range could be an important predictor for incidence of hypertension in Japanese community-dwelling elderly women. Keywords: Serum uric acid, Hypertension, Risk factor, Women, Community-dwelling person
Background Hypertension has increased significantly with time, and the increasing prevalence is an important public health concern in Japan [1] and other countries [2–4] because of the high prevalence and strong association with cardiovascular disease (CVD). However, approximately 90% * Correspondence: [email protected] 1 Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan 2 Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-city, Japan
of hypertensive cases are essential hypertension, the etiology of its onset is not fully understood. Although the etiology of essential hypertension is unknown, serum uric acid (SUA), the final product of the purine metabolism, has been hypothesized to activate intrarenal renin-angiotensin system (RAS), which can cause injury to pre-renal blood vessels [5]. For decades elevated SUA levels were mainly considered a result rather than a cause of renal dysfunction [6]. However lots of experimental and epidemiological studies have shown that high SUA in hu
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