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Urate-lowering therapy exerts protective effects against hypertension development in patients with gout

Journal of Human Hypertension volume 35, pages 351–359 (2021)Cite this article

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Abstract

Many studies have demonstrated that hyperuricemia is associated with hypertension (HTN) development, but few studies have explored whether urate-lowering therapy (ULT), which reverses hyperuricemia, decreases the risk of incident HTN. In this retrospective cohort study, we compared the risk of incident HTN of gout patients between those undergoing and not undergoing ULT. Risks of new-onset diabetes mellitus (DM) and chronic kidney disease (CKD) were also examined. In total, 2712 gout patients from 2000 to 2012 were enrolled. Overall incidence rates of HTN, DM, and CKD were compared between 1356 patients undergoing ULT recipients and 1356 matched control patients. After adjustment for sex, age, area, comorbidities, and drugs used, the incidence rates of HTN were 4.8 and 3.0 per 100 person years for non-ULT and ULT patients, respectively. ULT patients had a lower adjusted hazard ratio (aHR) of HTN (aHR: 0.64, 95% confidence interval [CI]: 0.54–0.75, p  <  0.001) than non-ULT patients. The lower risk of incident HTN after xanthine oxidase inhibitors exhibited a significant dose–response trend. ULT patients also had a lower risk of DM (aHR: 0.55, 95% CI: 0.43–0.70) than non-ULT patients. ULT patients exhibited no significant difference in CKD development (aHR: 1.04, 95% CI: 0.85–1.27) as compared with non-ULT patients. The present study revealed that ULT was associated with lower risks of incident HTN and DM, and the protective effect of xanthine oxidase inhibitors seemed to have a dose–response relationship.

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Fig. 1: Flow chart of the process of establishing the urate-lowering therapy and control cohorts using the National Health Insurance Research Database.
Fig. 2: Cumulative incidence of hypertension in patients receiving and not receiving urate-lowering therapy.

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Acknowledgements

This paper was edited by Wallace Academic Editing.

Funding

This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004); China Medical University Hospital; Academia Sinica Stroke Biosignature Project (BM10701010021); Taiwan Ministry of Science and Technology Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-); Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

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Author notes

  1. These authors contributed equally: Kuan-Hung Lin, Fu-Shun Yen

Authors and Affiliations

  1. Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan

    Kuan-Hung Lin

  2. Dr. Yen’s Clinic, Taoyuan City, Taiwan

    Fu-Shun Yen

  3. Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan

    Hsin-Lun Li

  4. Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung City, Taiwan

    Hsin-Lun Li

  5. Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan

    James Cheng-Chung Wei

  6. Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan

    Chih-Cheng Hsu

  7. Department of Health Services Administration, China Medical University, Taichung, Taiwan

    Chih-Cheng Hsu

  8. Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan

    Chih-Cheng Hsu

  9. Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chen-Chang Yang

  10. Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chen-Chang Yang

  11. Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chen-Chang Yang

  12. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Chii-Min Hwu

  13. Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chii-Min Hwu

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  1. Kuan-Hung Lin
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Contributions

KHL, FSY, CCY and CMH participated in the study design. JCCW and HLL participated in the study coordination and data collection. HLL, KHL, and CCH participated in the data analysis. All authors contributed to the interpretation of results as well as to the discussion. KHL, FSY, and CCY all participated in paper writing.

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Correspondence to Chen-Chang Yang or Chii-Min Hwu.

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Lin, KH., Yen, FS., Li, HL. et al. Urate-lowering therapy exerts protective effects against hypertension development in patients with gout. J Hum Hypertens 35, 351–359 (2021). https://doi.org/10.1038/s41371-020-0342-4

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