medigraphic.com
Colegio de Medicina Interna de México.

2018, Number 2

<< Back Next >>

Med Int Mex 2018; 34 (2)

Hyperuricemia and systemic arterial hypertension: what is the relationship?

Vázquez-Ávila JA, Zetina-Martínez M, Duarte-Mote J

Language: Spanish
References: 33
Page: 278-287
PDF size: 476.63 Kb.


ABSTRACT

Uric acid is the end product of purine metabolism, ultimately converted to uric acid. There is no universal definition of hyperuricemia, in practice, the cutoff point is from 6.8mg/dL in plasma. The relationship between hyperuricemia and hypertension has been demonstrated in many experimental studies. Experimental studies have shown a linear enpositive correlation between blood pressure and uric acid levels, as well as a decrease in blood pressure figures with therapy with allopurinol. Numerous mechanisms have been identified through which hyperuricemia can cause hypertension: reduction of endothelial nitric oxide levels, stimulation of oxidative stress, expression in smooth muscle cells of the vascular endothelium of URAT-1 receptor, activation of the renin-angiotensin axis, stimulation of vascular smooth muscle proliferation also favors the development of renal microvascular disease. Recent evidence has provided new insight into the multiple mechanisms through which UA would play a major role both in systemic arterial hypertension and in multiple metabolic alterations; however, large-scale, well-designed clinical studies are needed, which prove more conclusively these theories, before considering therapies focused on the management of asymptomatic hyperuricemia in daily clinical practice


REFERENCES

  1. Cecil & Goldman. Medicine, 25ª Ed. Enfermedad por depósito de cristales, 2015 Cap. 281:1742.

  2. McCrudden F. Uric acid: the chemistry, physiology and pathology of uric acid and the physiologically important purine bodies, with a discussion of the metabolism in gout. Paul Hoeber Medical Books; 1905.

  3. Preitner F, Bonny O, Laverriere A, et al. Glut is a major regulator of uratehomeostasis and its genetic inactivation induces hyperuricosuria and urate nephropathy. Proc Natl Acad Sci USA 2009;106(36):15501-15506.

  4. Hediger MA, Johnson RJ, Miyazaki H, Endou H. Molecular physiology of urate transport. Physiology (Bethesda) 2005;20:125-133.

  5. Yan Miao SA, et al. Effect of a reduction in uric acid on renal outcomes during losartan treatment a post hoc analysis of the reduction of endpoints in non-insulin-dependent diabetes mellitus with the angiotensin II antagonist losartan trial. Hypertension J 2012;1.

  6. Wright AF, Rudan I, Hastie ND, Campbell H. A 'complexity' of urate transporters. Kidney Int 2010 Sep;78(5):446-452. [PubMed: 20613716]

  7. Alvarez-Lario B, Macarron-Vicente J. Uric acid and evolution. Rheumatology (Oxford) 2010 Nov;49(11):2010-15. [PubMed: 20627967]

  8. American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. 2012;64(10), October: 1447-1461.

  9. Bobulescu A, et al. Renal transport of uric acid: evolving concepts and uncertainties ion. Adv Chronic Kidney Dis 2012 November;19(6):358-371.

  10. Sakhaee K, Adams-Huet B, Moe OW, Pak CY. Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int 2002;62(3):971-979. [PubMed: 12164880]

  11. Johnson RJ. Why focus on uric acid? Curr Med Res Opin 2015;31(Supl 2):3-7.

  12. Wang J, Qin T, et al. Hyperuricemia and risk of incident hypertension: A systematic review and meta-analysis of observational studies. PLoS One. 2014 Dec 1;9(12):e114259. doi: 10.1371/journal.pone.0114259. eCollection 2014

  13. Mazzali M, Hughes J, Kim YG, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001;38:1101-6.

  14. Sanchez-Lozada LG, Tapia E, Lopez-Molina R, et al. Effects of acute and chronic L-arginine treatment in experimental hiperuricemia. Am J Physiol Renal Physiol 2007 Apr;292(4):F1238-44.

  15. Kanellis J, Watanabe S, Li JH, et al. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension 2003;41:1287-93.

  16. Feig DI, Johnson RJ. Hyperuricemia in childhood primary hypertension. Hypertension 2003;42:247-52.

  17. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 2008;300:924-32.

  18. Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med 2012;125:302 e309-317.

  19. Hovind P, Rossing P, Tarnow L, et al. Serum uric acid as a predictor for development of diabetic nephropathy in type 1 diabetes: an inception cohort study. Diabetes 2009;58:1668-71.

  20. Kang DH, Nakagawa T, Feng L, et al. A role for uric acid in the progression of renal disease. J Am Soc Nephrol 2002;13:2888-97.

  21. Sanchez-Lozada LG, Soto V, Tapia E, et al. Role of oxidative stress in the renal abnormalities induced by experimental hyperuricemia. Am J Physiol 2008;295:F1134-41.

  22. Allopurinol enhances the blood pressure lowering effect of enalapril in children with hyperuricemic essential hypertension Farahnak Assadi. Published online: 13 December 2013. Italian Society of Nephrology 2013.

  23. Wurzner G, Gerster JC, Chiolero A, Mallard M, Fallab Stubi CL. Comparative effects of losartan and irbesartan on serum uric acid un hypertensive patients with hyperuricaemia and gout. J Hypertens 2001 Oct;19(10):1855-60.

  24. Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced Creactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005;16:3553-3562.

  25. Waring WS, Adwani SH, Breukels O, Webb DJ, Maxwell SR. Hyperuricaemia does not impair cardiovascular function in healthy adults. Heart 2004;90:155-159.

  26. Price KL, et al. Human vascular smooth muscle cells express a urate transporter. J Am Soc Nephrol 2006 Jul;17(7):1791- 5. Epub 2006 Jun 14.

  27. Wang J, et al. Hyperuricemia and risk of incident hypertension: A systematic review and meta-analysis of observational studies. PLoS One 2014; December 1;9(12):e114259.

  28. Mazzali M, et al. Hyperuricemia exacerbates chronic cyclosporine nephropathy. Transplantation 2001 April 15;71(7):900-5.

  29. Yui-Pong S. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis 2006;Vol 47, No 1 (January): 51-59.

  30. Jun-Xia Z, et al. Uric acid induces oxidative stress via an activation of the renin-angiotensin system in 3T3-L1 adipocytes. Springer, 2013.

  31. Perlstein TS, Gumieniak O, Hopkins PN, et al. Uric acid and the state of the intrarenal renin-angiotensin system in humans. Kidney Int 2004;66:1465-70.

  32. Rao GN, et al. Uric acid stimulates vascular smooth muscle cell proliferation by increasing platelet-derived growth factor A-chain expression. J Biol Chem 1991;266(13): 8604-8608.

  33. Chao HH, et al. Uric acid stimulates endothelin-1 gene expression associated with NADPH oxidase in human aortic smooth muscle cells. Acta Pharmacol Sin 2008 Nov;29(11):1301-12.




2020     |     www.medigraphic.com