How Should Serum Uric Acid Concentrations be Interpreted in Patients with Hypertension?

A large number of epidemiological studies have identified an association between high serum uric acid (SUA) concentrations and increased cardiovascular risk. However, the significance of this relationship has been difficult to interpret due to the co-existence of other cardiovascular risk factors. The relationship between SUA concentrations and morbidity appears particularly strong in patients with hypertension, and a number of recent studies have found that this relationship persists after adjusting for potential confounders. This paper reviews the potential mechanisms by which SUA might be causally related to cardiovascular disease in patients with hypertension. We critically appraise the evidence in favour of a causal, coincidental or compensatory relationship, and consider the potential outcomes of lowering SUA in patients with hypertension. The potential consequences of high SUA concentrations are discussed and, based on existing evidence, consideration is given to the potential therapeutic value of strategies to lower SUA as a means of cardiovascular risk reduction in patients with hypertension.