Do Uric Acid Lowering Drugs Reduce BP in Hypertensive Patients?

Multiple studies have proposed an link between hyperuricemia and hypertension
Multiple studies have proposed an link between hyperuricemia and hypertension

An updated Cochrane review concluded there was insufficient evidence to establish whether uric acid lowering treatments also lower blood pressure. The findings are published in the Cochrane Database of Systematic Reviews.

Multiple studies have proposed an association between hyperuricemia and hypertension with hyperuricemia affecting 25–40% of patients with untreated hypertension. This percentage is lower among patients with normal blood pressure or in the general population. It is still unknown, however, if reducing serum uric acid also lowers blood pressure (BP). 

Study authors aimed to evaluate whether uric acid lowering drugs also reduced blood pressure in patients with primary hypertension or prehypertension when compared to placebo. To determine this, they searched for randomized controlled trials in various databases that met the inclusion criteria. 

A total of 349 abstracts were identified, of which 21 were included for review. Three ongoing studies with unavailable results, and three other randomized controlled trials enrolling patients were included in the meta-analysis. 

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In general, there was low quality evidence from three trials indicating no reduction in systolic (–6.2mmHg, 95% CI: –12.8 to 0.5) or diastolic (–3.9mmHg, 95% CI: –9.2 to 1.4) 24-hour ambulatory BP with uric acid lowering drugs vs. placebo. 

In addition, there was low quality evidence from two trials indicating a decrease in systolic clinic BP (–8.43mmHg, 95% CI: –15.24 to –1.62) but not diastolic clinic BP (–6.45mmHg, 95% CI: –13.60 to 0.70). 

The review found high quality evidence from three trials demonstrating that serum uric acid levels were reduced by 3.1mg/dL (95% CI: 2.4 to 3.8) in study patients that received uric acid lowering treatments. Moreover, there was very low quality evidence from three trials suggesting that drug therapy was not associated with withdrawals due to adverse effects (RR 1.86, 95% CI: 0.43 to 8.10).

Additional research is needed to determine whether uric acid lowering drugs also lower blood pressure, the authors concluded.

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