Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: Case histories

A number of studies have shown that hyperuricaemia is associated with an in creased incidence of coronary heart disease. It has been proposed that the elevated serum uric acid levels are linked to other risk factors, such as h ypertension, dyslipidaemia and diabetes. Hyperuricaemia is commonly encount ered in patients with essential hypertension and is considered as a risk fa ctor for morbidity and mortality associated with hypertension. In addition, lipid abnormalities (mainly hypertriglyceridaemia) are also found more fre quently in hypertensive patients than in normotensives. There is evidence t hat the angiotensin II receptor antagonist, losartan, increases urate excre tion by reducing reabsorption of urate in the renal proximal tubule. It is also known that fibric acid derivatives (fibrates) have several beneficial actions in addition to their lipid-lowering capacity. Fenofibrate administr ation is associated with a uric acid lowering effect. lit this respect, we present two patients with hypertension and dyslipidaemia together with elev ated serum uric acid levels. We also discuss (in the format of questions an d answers) the pathophysiological mechanisms underlying the association of serum uric acid with cardiovascular disease, and we review the relevant lit erature to justify an evidence-based decision to choose an antihypertensive agent (losartan) or a lipid-lowering drug (fenofibrate) with an additional hypouricaemic effect.