Pharmacotherapy for hyperuricemia in hypertensive patients

• Published in: Cochrane database of systematic reviews 2017-04, Vol.4 (4), p.CD008652
• Main Authors: Gois, Pedro Henrique França, Souza, Edison Regio de Moraes
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allopurinol - therapeutic use; Blood Pressure - drug effects; Child; Humans; Hypertension - complications; Hypertension - drug therapy; Hyperuricemia - complications; Hyperuricemia - drug therapy; Medicine General & Introductory Medical Sciences; Patient Dropouts - statistics & numerical data; Prehypertension - drug therapy; Randomized Controlled Trials as Topic; Uricosuric Agents - therapeutic use
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008652.pub3

High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricemia and hypertension. Hyperuricemia affects 25% to 40 % of individuals with untreated hypertension; a much lower prevalence has been reported in normotensives or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP) is an unanswered question. To determine whether UA-lowering agents reduce BP in patients with primary hypertension or prehypertension compared with placebo. The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2016: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 2), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS up to March 2016 and contacted authors of relevant papers regarding further published and unpublished work. To be included in this review, the studies had to meet the following criteria: 1) randomized or quasi-randomized, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind or open-label; 3) parallel or cross-over trial; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension, and hyperuricemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men and 5.5 mg/dL in children/adolescents); 7) outcome measures assessed included change in clinic systolic, diastolic or 24-hour ambulatory BP. The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane Collaboration' Risk of bias' tool. In this review update, we examined the abstracts of 349 identified papers and selected 21 for evaluation. We also identified three ongoing studies, the results of which are not yet available. Three other randomized controlled trials (RCTs) (two new), enrolling individuals with hypertension or prehypertension, and hyperuricemia, met the inclusion criteria for the review and were included in the met