Serum uric acid and cardiovascular events in successfully treated hypertensive patients

To determine whether pretreatment and/or in-treatment serum uric acid (SUA) is independently and specifically associated with cardiovascular events in hypertensive patients, we examined the 20-year experience of 7978 mild-to- moderate hypertensive participants in a systematic worksite treatment progr am. Clinical-evaluation and treatment were protocol-directed. SUA was measu red. at entry and annually thereafter. Subjects were stratified according t o gender-specific quartile of baseline SUA. Blood pressures at entry and in -treatment were, respectively, 152.5/95.6 and 138.9/85.4 mm Hg. SUA was nor mally distributed with a mean of 0.399 +/- 0.0893 and 0.321 +/- 0.0833 mmol /l for men and women, respectively. Subjects with highest SUA were heavier, had: greater evidence of cardiovascular disease (CVD), higher systolic blo od pressure, higher creatinine, more frequent diuretic use, and lower preva lence of diabetes, During an average follow-up of 6.6 years (52 751 patient -years); 548 CVD events (183 mortal) and 116 non-CVD events occurred. In bi variate analysis, the association of SUA to CVD was more robust in nonwhite s than whites and in patients at low versus high CVD risk. In multivariate analysis, CVD incidence was significantly associated with SUA with a hazard ratio of 1.22 (95% confidence interval 1.11 to 1.35), controlling:for othe r known cardiovascular risk factors, including serum creatinine, body mass index, and diuetic use. Despite blood pressure control, SUA levels increase d during treatment and were significantly and directly associated with CVD events, independently of diuretic use and other cardiovascular risk factors .