The role of uric acid in the risk of hypertension developed from prehypertension: a five-year Chinese urban cohort study | Archives of Public Health

Baseline characteristics

The baseline characteristics of subjects with prehypertension are shown in Table 1. Among the 1,516 subjects eventually enrolled, the mean age of the total was 55.0 ± 10.1 years (range 35–84 years), including 966 (63.7%) male and 550 (36.3%) female, and 243 (16.0%) subjects were found to have hyperuricemia in 2017. Males with prehypertension were more likely to be younger, with a smoking history, and higher clinical measures for BMI, diastolic blood pressure, FBG, total triglyceride (TG), serum creatinine (Scr), urea nitrogen (BUN), alanine aminotransferase (ALT), albumin and globulin ratio (A/G), red blood cell counts, mean corpuscular volume (MCV), white blood cell counts, hemoglobin, and serum uric acid levels compared with female subjects (p < 0.05). The levels of systolic blood pressure, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and eGFR were higher in females than those in males (p < 0.05). There was not significantly difference in the concentrations of aspartate aminotransferase (AST) and low-density lipoprotein cholesterol (LDL-C) by gender (p > 0.05).

Cumulative incidences of hypertension over five years

The overall cumulative incidence of hypertension over five years was 35.1%, and gender showed no significant difference to the development of hypertension (males 33.9% vs. females 37.3%, p = 0.180). As shown in Fig. 2, subjects with hyperuricemia had a higher cumulative incidence of hypertension over 5 years compared to those with normouricemia (40.7% vs. 34.0%, p = 0.041), and after stratifying by gender, the cumulative incidence of hypertension in male subjects with hyperuricemia was significantly higher than that in normouricemic subjects (40.3% vs. 32.3%, p = 0.033). However, there was no significant difference observed in female subjects (42.3% vs. 36.8%, p = 0.418).

Cumulative incidences of hypertension from prehypertension in the five-year study of a Chinese urban cohort from 2017 to 2022. Legend: In the overall population, the cumulative incidence of hypertension over five years was 40.74% in the hyperuricemia group, and 34.01% in the non-hyperuricemia group; In males, the cumulative incidence of hypertension over five years was 40.31% in the hyperuricemia group, and 32.26% in the non-hyperuricemia group; In females, the cumulative incidence of hypertension over five years was 42.31% in the hyperuricemia group, and 36.75% in the non-hyperuricemia group

Multivariate analysis of the risk factors for hypertension from prehypertension

A multivariate logistic regression analysis, adjusting for age, gender, BMI, systolic blood pressure, diastolic blood pressure, smoking status, FBG, TG, TC, HDL-C, LDL-C, eGFR, and hyperuricemia, was performed to evaluate the risk of hypertension from prehypertension. As presented in Fig. 3, age (adjusted OR = 1.04; 95% CI, 1.02–1.05; p < 0.001), female (adjusted OR = 1.35; 95% CI, 1.03–1.78; p = 0.031), higher baseline systolic blood pressure (adjusted OR = 1.09; 95% CI, 1.06–1.10; p < 0.001) and diastolic blood pressure (adjusted OR = 1.04; 95% CI 1.02–1.06; p < 0.001), smoking status (adjusted OR = 1.36; 95%CI, 1.02–1.81; p = 0.037), and hyperuricemia (adjusted OR = 1.44; 95% CI, 1.05–1.98; p = 0.022) were significantly associated with the risk for developing hypertension. However, serum uric acid levels per 1 mg/dl increase (adjusted OR = 1.10; 95% CI, 0.98–1.24; p = 0.097) had no positive relationship with the development of hypertension after adjustment.

Multivariate logistic regression analysis of the risk factors for developing hypertension from prehypertension in the five-year study of a Chinese urban cohort from 2017 to 2022. Legend: Model was adjusted for age, gender, BMI, systolic BP, diastolic BP, smoking, FBG, TG, TC, HDL-C, LDL-C, eGFR, and hyperuricemia (or SUA). SUA, serum uric acid; eGFR, estimated glomerular filtration rate; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TC, total cholesterol; TG, total triglyceride; FBG, fasting plasma glucose; BP, blood pressure; BMI, body mass index

Subgroup analysis of the risk for hypertension by hyperuricemia based on gender

As shown in Table 2, after adjusting for age, BMI, systolic blood pressure, diastolic blood pressure, smoking status, FBG, TG, TC, HDL-C, LDL-C and eGFR, hyperuricemia significantly increased the risk of hypertension in male group (adjusted OR = 1.55; 95%CI, 1.07–2.23; p = 0.020), but the difference in female group was not statistically significant (adjusted OR = 1.10; 95%CI, 0.58–2.09; p = 0.781). In addition, no interaction was found between gender and hyperuricemia to influence the risk of developing hypertension (p = 0.102).

Further dividing serum uric acid into four levels by gender evaluated the effect of serum uric acid on the risk of hypertension. As presented in Table 3, after adjusting for age, BMI, systolic blood pressure, diastolic blood pressure, smoking status, fasting blood glucose, TG, TC, HDL-C, LDL-C and eGFR, subjects with the highest serum uric acid level had a 1.67-fold higher risk of developing hypertension than those with the lowest level in male (adjusted OR = 1.67; 95%CI, 1.07–2.63; p = 0.025). However, in female subjects, none of the three groups with the high levels of serum uric acid were positively associated with the risk of hypertension compared to the group with the lowest level (p > 0.05). Moreover, there was also no interaction between gender and serum uric acid concentration on the risk of developing hypertension (p = 0.106).

Subgroup analysis of the risk for hypertension by hyperuricemia based on age

As presented in Table 4, hyperuricemia had a positive association with the risk of hypertension in the age < 60 years group (adjusted OR = 1.52; 95%CI, 1.04–2.24; p = 0.033). While the similar relation was not found in the age ≥ 60 years group (adjusted OR = 1.07; 95%CI, 0.61–1.88; p = 0.814), there was an interaction between age and hyperuricemia on the risk of developing hypertension (p = 0.034).

Propensity score matching

Using 12 baseline covariates, 235 of 243 hyperuricemia subjects successfully matched with those without hyperuricemia thorough propensity score matching. As shown in Table 5, participants with hyperuricemia had a significantly higher risk of hypertension from prehypertension over 5 years compared with non-hyperuricemia individuals (41.3% vs. 32.3%, p = 0.045).