Lv. Franse et al., Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP), J HYPERTENS, 18(8), 2000, pp. 1149-1154
Citations number
28
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective To assess longitudinally the association of serum uric acid and i
ts change due to diuretic treatment with cardiovascular events in hypertens
ive patients.
Design Cohort study in a randomized trial.
Setting Cohort of hypertensive patients.
Participants A total of 4327 men and women, aged greater than or equal to 6
0 years, with isolated systolic hypertension, randomized to placebo or chlo
rthalidone, with the addition of atenolol or reserpine if needed, were obse
rved for 5 years.
Main outcome measures Major cardiovascular events, coronary events, stroke
and all-cause mortality.
Results Cardiovascular event rates for quartiles of baseline serum uric aci
d were: I, 32.7 per 1000 person-years; II, 34.5 per 1000 person-years; III,
38.1 per 1000 person-years; and IV, 41.4 per 1000 person-years (P for tren
d = 0.02). The adjusted hazard ratio (HR), of cardiovascular events for the
highest quartile of serum uric acid versus the lowest quartile was 1.32 (9
5% CI, 1.03-1.69). The benefit of active treatment was not affected by base
line serum uric acid. After randomization, an increase of serum uric acid <
0.06 mmol/l (median change) in the active treatment group was associated w
ith a HR of 0.58 (0.37-0.92) for coronary events compared with those with a
serum uric acid increase greater than or equal to 0.06 mmol/l. This differ
ence was not explained by blood pressure effects. Those with a serum uric a
cid increase greater than or equal to 0.06 mmol/l in the active treatment g
roup had a similar risk of coronary events as the placebo group.
Conclusions Serum uric acid independently predicts cardiovascular events in
older persons with isolated systolic hypertension. Monitoring serum uric a
cid change during diuretic treatment may help to identify patients who will
most benefit from treatment. J Hypertens 2000, 18:1149-1154 (C) Lippincott
Williams & Wilkins.