The Impacts of Serum Uric Acid on Arterial Hemodynamics, Hypertension and Cardiovascular Risks

• Main Authors: Pai-Feng Hsu, 許百豐
• Other Authors: Chen-Huan Chen
• Format: Others
• Language: en_US
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/01500266732322220725

博士 === 國立陽明大學 === 公共衛生研究所 === 103 === Hyperuricemia, and gout as its clinical manifestation, is a metabolic disease process that has been known from antiquity. Uric acid has been hypothesized as a risk factor or a mediator of cardiovascular disease for some time. Epidemiological studies have demonstrated that hyperuricemia is associated with hypertension, development of hypertension, and cardiovascular events. Recent animal studies showed that high uric acid levels raise blood pressure, and clinical trials of urate lowering therapy can lower blood pressure. Whether hyperuricemia causes cardiovascular diseases through elevation of blood pressure deserves further investigation. However, how hyperuricemia modulates hypertension remains poorly understood due to lack of relevant hemodynamics epidemiological studies. Recent epidemiological and clinical studies indicate that both arterial stiffness and increased arterial wave reflections are causes for the development of hypertension. Measures of brachial systolic and diastolic blood pressures in the office represent only a fraction of the blood pressure profile. Noninvasively measured central aortic blood pressure has better prognostic value than the brachial blood pressure. Out-of-office blood pressure values measured by 24-hour blood pressure monitoring or home blood pressure monitoring are more clinically relevant to the office blood pressure values. Blood pressure is a highly variable physiological trait. Variability of blood pressure values may also have important clinical significance. Therefore, a blood pressure profile should include average blood pressure values and blood pressure variability. Similarly, a comprehensive hypertension study should include measurements of central blood pressure, 24-hour blood pressure and blood pressure variability. In a series of studies, we have demonstrated the independent association of serum uric acid with central blood pressure and arterial wave reflections. Short-term systolic blood pressure variability independently predicts long-term cardiovascular risk beyond the Framingham risk score and the 24-hour systolic blood pressure. Serum uric acid is also independently associated with the 24-hour systolic blood pressure and systolic blood pressure variability. Finally, we also observed that hyperuricemia is independently associated with future cardiovascular diseases. However, adding hyperuricemia may not significantly improve the predictive power of Framingham risk score. The results of the serial hemodynamics epidemiological studies may help clinicians understand the pathophysiological role of hyperuricemia in the development of hypertension and cardiovascular diseases.