Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
  • Published:

High serum uric acid is a risk factor for arterial stiffness in a Chinese hypertensive population: a cohort study

A Comment to this article was published on 14 March 2024

Abstract

The prospective cohort study was to explore the association between serum uric acid (SUA) and arterial stiffness in a Chinese hypertensive population. A total of 7444 participants with hypertension who completed two or more measurements of brachial-ankle pulse wave velocity (baPWV) and baseline SUA detection were followed-up in the Kailuan Study from 2010 to 2020. A restricted cubic spline curve was used to verify whether there was a linear association between baseline SUA and arterial stiffness. A Cox proportional hazard regression model was used to explore the association of between baseline SUA and the incidence of arterial stiffness. Our results showed that the restricted cubic spline curve revealed a linear relationship between baseline SUA and arterial stiffness in total participants (p < 0.001). After follow-up 4.6 ± 2.8 years, Kaplan–Meier survival curves indicated that the risk of arterial stiffness was increased in the high level of baseline SUA (Log-rank p = 0.0002). After adjusting for potential confounding factors, the HR (95% CI) for risk of stiffness was 1.33 (1.17–1.52, p < 0.001) in the highest SUA group. Hierarchical analysis showed that the HRs (95% CI) for risk of arterial stiffness were 1.45 (1.25–1.69), 1.38 (1.19–1.60), 1.41 (1.21–1.64), and 1.35 (1.15–1.58) in the highest SUA group of males, <65 years old, not taking antihypertensive drugs, and failure to achieve the control targets of blood pressure respectively (p < 0.001). These results reveal that high SUA is a risk factor for arterial stiffness in the Chinese hypertensive population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wang Q, Wen X, Kong J. Recent progress on uric acid detection: a review. Crit Rev Anal Chem. 2020;50:359–75.

    CAS  PubMed  Google Scholar 

  2. Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8–14.

    PubMed  Google Scholar 

  3. Yanai H, Adachi H, Hakoshima M, Katsuyama H. Molecular biological and clinical understanding of the pathophysiology and treatments of hyperuricemia and its association with metabolic syndrome, cardiovascular diseases and chronic kidney disease. Int J Mol Sci. 2021;22:9221.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Wang Y, Zhang XY, Gao WH, Du MF, Chu C, Wang D, et al. Association of uric acid in serum and urine with arterial stiffness: Hanzhong adolescent hypertension study. Dis Markers. 2020;2020:1638515.

    PubMed  PubMed Central  Google Scholar 

  5. Albu A, Para I, Porojan M. Uric acid and arterial stiffness. Ther Clin Risk Manag. 2020;16:39–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Nagano S, Takahashi M, Miyai N, Oka M, Utsumi M, Shiba M, et al. Association of serum uric acid with subsequent arterial stiffness and renal function in normotensive subjects. Hypertens Res. 2017;40:620–4.

    CAS  PubMed  Google Scholar 

  7. Jiang Y, Ge JY, Zhang YY, Wang FF, Ji Y, Li HY. The relationship between elevated serum uric acid and arterial stiffness in a healthy population. Vascular. 2020;28:494–501.

    CAS  PubMed  Google Scholar 

  8. Kang HH, Won KB, Heo R, Han D, Chang HJ. Independent association of serum uric acid levels with arterial stiffness in the absence of established cardiovascular disorders. Int J Clin Pr. 2021;75:e13720.

    CAS  Google Scholar 

  9. De Feo M, Del Pinto R, Pagliacci S, Grassi D, Ferri C, Italian Society of Hypertension and Federfarma, et al. Real-world hypertension prevalence, awareness, treatment, and control in adult diabetic individuals: an Italian Nationwide Epidemiological Survey. High Blood Press Cardiovasc Prev. 2021;28:301–7.

    PubMed  PubMed Central  Google Scholar 

  10. Milan A, Zocaro G, Leone D, Tosello F, Buraioli I, Schiavone D, et al. Current assessment of pulse wave velocity: comprehensive review of validation studies. J Hypertens. 2019;37:1547–57.

    CAS  PubMed  Google Scholar 

  11. An LN, Rong N, Ning M, Feng LL, Chen ZH, Liu WQ, et al. High serum uric acid is associated with increased arterial stiffness in hypertension. Aging. 2020;12:14569–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Wang C, Yuan Y, Zheng M, Pan A, Wang M, Zhao M, et al. Association of age of onset of hypertension with cardiovascular diseases and mortality. J Am Coll Cardiol. 2020;75:2921–30.

    PubMed  Google Scholar 

  13. Zheng M, Zhang X, Chen S, Song Y, Zhao Q, Gao X, et al. Arterial stiffness preceding diabetes: a longitudinal study. Circ Res. 2020;127:1491–8.

    CAS  PubMed  Google Scholar 

  14. Wu S, Xu L, Wu M, Chen S, Wang Y, Tian Y. Association between triglyceride-glucose index and risk of arterial stiffness: a cohort study. Cardiovasc Diabetol. 2021;20:146.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Song M, Li N, Yao Y, Wang K, Yang J, Cui Q, et al. Longitudinal association between serum uric acid levels and multiterritorial atherosclerosis. J Cell Mol Med. 2019;23:4970–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Han Y, Liu Y, Liu X, Yang W, Yu P, Wang J, et al. Association between cumulative serum urate and development of diabetes type II: the Kailuan study. Clin Rheumatol. 2020;39:339–46.

    PubMed  Google Scholar 

  17. Wu S, Jin C, Li S, Zheng X, Zhang X, Cui L, et al. Aging, arterial stiffness, and blood pressure association in Chinese adults. Hypertension. 2019;73:893–9.

    CAS  PubMed  Google Scholar 

  18. Wu Y, Liu Q, Ma Y, Han X, Zhao X, Zhao H, et al. Effect of parental arterial stiffness in offspring: the Kailuan study. J Hypertens. 2022;40:102–7.

    PubMed  Google Scholar 

  19. Takashima N, Turin TC, Matsui K, Rumana N, Nakamura Y, Kadota A, et al. The relationship of brachial-ankle pulse wave velocity to future cardiovascular disease events in the general Japanese population: the Takashima study. J Hum Hypertens. 2014;28:323–7.

    CAS  PubMed  Google Scholar 

  20. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    PubMed  PubMed Central  Google Scholar 

  21. Kerner W, Bruckel J. German diabetes A. Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes. 2014;122:384–6.

    CAS  PubMed  Google Scholar 

  22. Civeira F, Arca M, Cenarro A, Hegele RA. A mechanism-based operational definition and classification of hypercholesterolemia. J Clin Lipido. 2022;16:813–21.

    Google Scholar 

  23. Yang AL, McNabb-Baltar J. Hypertriglyceridemia and acute pancreatitis. Pancreatology. 2020;20:795–800.

    CAS  PubMed  Google Scholar 

  24. Miyoshi T, Ito H. Arterial stiffness in health and disease: the role of cardio-ankle vascular index. J Cardiol. 2021;78:493–501.

    PubMed  Google Scholar 

  25. Munakata M. Brachial-ankle pulse wave velocity: background, method, and clinical evidence. Pulse. 2016;3:195–204.

    PubMed  PubMed Central  Google Scholar 

  26. Lee JG, Joo SJ. Arterial stiffness and cardiovascular risk. Korean J Intern Med. 2019;34:504–6.

    PubMed  PubMed Central  Google Scholar 

  27. Sanchez Bacaicoa C, Rico-Martin S, Morales E, Guimaraes Cunha P, Rodilla E, Lozano J, et al. Brachial-ankle pulse wave velocity with a custom device. Rev Clin Esp. 2021;221:145–50.

    PubMed  Google Scholar 

  28. Rhee TM, Kim HL, Oh S, Lim WH, Seo JB, Chung WY, et al. Gender difference in the association between brachial-ankle pulse wave velocity and cardiovascular risk scores. Korean J Intern Med. 2019;34:539–48.

    CAS  PubMed  Google Scholar 

  29. Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement—a survey of 12517 subjects. Atherosclerosis. 2003;166:303–9.

    CAS  PubMed  Google Scholar 

  30. Carlini NA, Harber MP, Fleenor BS. Age-related carotid extra-media thickening is associated with increased blood pressure and arterial stiffness. Clin Physiol Funct Imaging. 2021;41:461–6.

    CAS  PubMed  Google Scholar 

  31. Jaruchart T, Suwanwela NC, Tanaka H, Suksom D. Arterial stiffness is associated with age-related differences in cerebrovascular conductance. Exp Gerontol. 2016;73:59–64.

    PubMed  Google Scholar 

  32. Choi SY, Oh BH, Bae Park J, Choi DJ, Rhee MY, Park S. Age-associated increase in arterial stiffness measured according to the cardio-ankle vascular index without blood pressure changes in healthy adults. J Atheroscler Thromb. 2013;20:911–23.

    PubMed  Google Scholar 

  33. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and cardiovascular risk in hypertension. Circ Res. 2021;128:864–86.

    CAS  PubMed  Google Scholar 

  34. Lage JGB, Bortolotto AL, Scanavacca MI, Bortolotto LA, Darrieux F. Arterial stiffness and atrial fibrillation: a review. Clinics. 2022;77:100014.

    PubMed  PubMed Central  Google Scholar 

  35. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;74:1237–63.

    PubMed  PubMed Central  Google Scholar 

  36. Voicehovska JG, Bormane E, Grigane A, Moisejevs G, Moreino E, Trumpika D, et al. Association of arterial stiffness with chronic kidney disease progression and mortality. Heart Lung Circ. 2021;30:1694–701.

    PubMed  Google Scholar 

  37. Oikonomou E, Karlis D, Tsalamadris S, Siasos G, Chrysohoou C, Vogiatzi G, et al. Galectin-3 and arterial stiffness in patients with heart failure: a pilot study. Curr Vasc Pharm. 2019;17:396–400.

    CAS  Google Scholar 

  38. Singal AK, Karthikeyan G. Aspirin for primary prevention: is this the end of the road? Indian Heart J. 2019;71:113–7.

    PubMed  PubMed Central  Google Scholar 

  39. Titko T, Perekhoda L, Drapak I, Tsapko Y. Modern trends in diuretics development. Eur J Med Chem. 2020;208:112855.

    CAS  PubMed  Google Scholar 

  40. Mingatto FE, Santos AC, Uyemura SA, Jordani MC, Curti C. In vitro interaction of nonsteroidal anti-inflammatory drugs on oxidative phosphorylation of rat kidney mitochondria: respiration and ATP synthesis. Arch Biochem Biophys. 1996;334:303–8.

    CAS  PubMed  Google Scholar 

  41. Moreno-Sanchez R, Bravo C, Vasquez C, Ayala G, Silveira LH, Martinez-Lavin M. Inhibition and uncoupling of oxidative phosphorylation by nonsteroidal anti-inflammatory drugs: study in mitochondria, submitochondrial particles, cells, and whole heart. Biochem Pharm. 1999;57:743–52.

    CAS  PubMed  Google Scholar 

  42. Pietri P, Vlachopoulos C, Terentes-Printzios D, Xaplanteris P, Aznaouridis K, Petrocheilou K, et al. Beneficial effects of low-dose aspirin on aortic stiffness in hypertensive patients. Vasc Med. 2014;19:452–7.

    CAS  PubMed  Google Scholar 

  43. Okada Y, Shibata S, Fujimoto N, Best SA, Levine BD, Fu Q. Long-term effects of a renin inhibitor versus a thiazide diuretic on arterial stiffness and left ventricular diastolic function in elderly hypertensive patients. Am J Physiol Regul Integr Comp Physiol. 2017;313:R400–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Katsiki N, Dimitriadis GD, Mikhailidis DP. Serum uric acid and diabetes: from pathophysiology to cardiovascular disease. Curr Pharm Des. 2021;27:1941–51.

    CAS  PubMed  Google Scholar 

  45. Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta. 2018;484:150–63.

    CAS  PubMed  Google Scholar 

  46. Maloberti A, Giannattasio C, Bombelli M, Desideri G, Cicero AFG, Muiesan ML, et al. Hyperuricemia and risk of cardiovascular outcomes: the experience of the URRAH (Uric Acid Right for Heart Health) Project. High Blood Press Cardiovasc Prev. 2020;27:121–8.

    PubMed  Google Scholar 

  47. Sugiura T, Dohi Y, Takagi Y, Yokochi T, Yoshikane N, Suzuki K, et al. Increased impact of serum uric acid on arterial stiffness and atherosclerosis in females. J Atheroscler Thromb. 2022;29:1672–91.

    PubMed  PubMed Central  Google Scholar 

  48. Hwang J, Hwang JH, Chung SM, Kwon MJ, Ahn JK. Association between serum uric acid and arterial stiffness in a low-risk, middle-aged, large Korean population: a cross-sectional study. Medicine. 2018;97:e12086.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Vlachopoulos C, Xaplanteris P, Vyssoulis G, Bratsas A, Baou K, Tzamou V, et al. Association of serum uric acid level with aortic stiffness and arterial wave reflections in newly diagnosed, never-treated hypertension. Am J Hypertens. 2011;24:33–9.

    PubMed  Google Scholar 

  50. Rebora P, Andreano A, Triglione N, Piccinelli E, Palazzini M, Occhi L, et al. Association between uric acid and pulse wave velocity in hypertensive patients and in the general population: a systematic review and meta-analysis. Blood Press. 2020;29:220–31.

    CAS  PubMed  Google Scholar 

  51. Cicero AF, Salvi P, D’Addato S, Rosticci M, Borghi C,Brisighella Heart Study Group. Association between serum uric acid, hypertension, vascular stiffness and subclinical atherosclerosis: data from the Brisighella Heart Study. J Hypertens. 2014;32:57–64.

    CAS  PubMed  Google Scholar 

  52. Ramirez AJ, Christen AI, Sanchez RA. Serum uric acid elevation is associated to arterial stiffness in hypertensive patients with metabolic disturbances. Curr Hypertens Rev. 2018;14:154–60.

    CAS  PubMed  Google Scholar 

  53. Bae JS, Shin DH, Park PS, Choi BY, Kim MK, Shin MH, et al. The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: the Korean Multi-Rural Communities Cohort study. Atherosclerosis. 2013;231:145–51.

    CAS  PubMed  Google Scholar 

  54. Chen X, Li Y, Sheng CS, Huang QF, Zheng Y, Wang JG. Association of serum uric acid with aortic stiffness and pressure in a Chinese workplace setting. Am J Hypertens. 2010;23:387–92.

    CAS  PubMed  Google Scholar 

  55. Wang H, Ba Y, Gao X, Zhuo J, Li Y, Sun J, et al. Association between serum uric acid to high density lipoprotein-cholesterol ratio and arterial stiffness in a Japanese population. Medicine. 2023;102:e34182.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Tian X, Chen S, Wang P, Xu Q, Zhang Y, Zhang X, et al. The impact of serum acid, arterial stiffness, and hypertension as a mediating factor: a cohort study. Hellenic J Cardiol. 2023. https://doi.org/10.1016/j.hjc.2023.07.009.

Download references

Acknowledgements

We thank the staff and participants of the Kailuan Study for their important contributions.

Funding

This study was supported by the National Key R&D Program of China (2020YFC2004703), National Natural Science Foundation of China (82070335 and 82370250), Research Project of the Shanghai Municipal Health Commission (202240036), and Project of Songjiang District Science and Technology in Shanghai (21SJKJGG48).

Author information

Authors and Affiliations

Authors

Contributions

LA: designing the project, statistical analysis, writing the original draft; LL and YW: statistical analysis, data cleansing; CM: statistical analysis; LX: data cleansing; GW: review and editing; DZ, SW and JH: resources, data curation, project administration, review and editing.

Corresponding authors

Correspondence to Desheng Zhu, Shouling Wu or Jiang Hong.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

An, L., Wang, Y., Liu, L. et al. High serum uric acid is a risk factor for arterial stiffness in a Chinese hypertensive population: a cohort study. Hypertens Res 47, 1512–1522 (2024). https://doi.org/10.1038/s41440-024-01591-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-024-01591-0

Keywords

This article is cited by

Search

Quick links