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Meta-Analysis
. 2020 Sep 2;9(9):CD008652.
doi: 10.1002/14651858.CD008652.pub4.

Pharmacotherapy for hyperuricaemia in hypertensive patients

Pedro Henrique França Gois  1 , Edison Regio de Moraes Souza  2
Affiliations
Meta-Analysis

Pharmacotherapy for hyperuricaemia in hypertensive patients

Pedro Henrique França Gois et al. Cochrane Database Syst Rev. .

Abstract

Background: This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricaemia and hypertension. Hyperuricaemia affects 25% to 40% of those with untreated hypertension; a much lower prevalence has been reported in those with normotension or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP), is an unanswered question.

Objectives: To determine whether UA-lowering agents reduce BP in people with primary hypertension or prehypertension, compared with placebo.

Search methods: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2020: the Cochrane Hypertension Specialised Register, CENTRAL 2018, Issue 12, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS (1982 to May 2020), and contacted authors of relevant papers regarding further published and unpublished work. The searches had no language or date restrictions.

Selection criteria: To be included in this updated review, the studies had to meet the following criteria: 1) randomised or quasi-randomised, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind, or open-label; 3) parallel or cross-over trial design; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension plus hyperuricaemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men, and 5.5 mg/dL in children or adolescents); 7) outcome measures included change in 24-hour ambulatory systolic or diastolic BP, or both; or clinic-measured systolic or diastolic BP, or both.

Data collection and analysis: The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We assessed the certainty of the evidence using the GRADE approach.

Main results: In this review update, we screened 722 records, selected 26 full-text reports for evaluation. We identified no ongoing studies and did not add any new studies. We included three randomised controlled trials (RCTs), enrolling 211 people with hypertension or prehypertension, plus hyperuricaemia. Low-certainty evidence from three RCTs found inconclusive results between those who received UA-lowering drugs and placebo, in 24-hour ambulatory systolic (MD -6.2 mmHg, 95% CI -12.8 to 0.5) or diastolic BP (-3.9 mmHg, 95% CI -9.2 to 1.4). Low-certainty evidence from two RCTs found that UA-lowering drugs reduced clinic-measured systolic BP (-8.43 mmHg, 95% CI -15.24 to -1.62) but results for clinic-measured diastolic BP were inconclusive (-6.45 mmHg, 95% CI -13.60 to 0.70). High-certainty evidence from three RCTs found that serum UA levels were reduced by 3.1 mg/dL (95% CI 2.4 to 3.8) in the participants that received UA-lowering drugs. Low-certainty evidence from three RCTs found inconclusive results regarding the occurrence of adverse events between those who received UA-lowering drugs and placebo (RR 1.86, 95% CI 0.43 to 8.10).

Authors' conclusions: In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed.

Trial registration: ClinicalTrials.gov NCT01472692.

PubMed Disclaimer

Conflict of interest statement

Gois P: nothing to declare

Souza E: nothing to declare

Figures

1
1
Flow diagram of the study selection
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 1: 24‐h ambulatory systolic blood pressure
1.2
1.2. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 2: 24‐h ambulatory diastolic blood pressure
1.3
1.3. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 3: Clinic‐measured systolic blood pressure
1.4
1.4. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 4: Clinic‐measured diastolic blood pressure
1.5
1.5. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 5: Serum uric acid
1.6
1.6. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 6: Adverse events
1.7
1.7. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 7: 24‐h ambulatory systolic blood pressure in adolescents (subgroup analysis)
1.8
1.8. Analysis
Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 8: 24‐h ambulatory diastolic blood pressure in adolescents (subgroup analysis)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

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Pour‐Pouneh 2015 {published data only}
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Tani 2015 {published data only}
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References to studies awaiting assessment

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Associated data