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Prognostic value of serum uric acid: new-onset in and out-of-office hypertension and long-term mortality

Bombelli, Michelea,b; Ronchi, Irenea; Volpe, Marcoa; Facchetti, Ritaa; Carugo, Stefanob; Dell’Oro, Raffaellaa; Cuspidi, Cesareb,c; Grassi, Guidoa,b,d; Mancia, Giuseppeb,c

doi: 10.1097/HJH.0000000000000161

Objective: Serum uric acid (SUA) has been associated with an increased cardiovascular risk, but no conclusive evidence exists on whether it is an independent risk factor or a reflection of other risk factors to which it is related. We examined the relationship of SUA with a number of cardiovascular variables [including risk factors never evaluated before, such as organ damage and out-of-office blood pressure (BP)], as well as its prognostic relevance in the population.

Methods: In 2045 participants of the Pressioni Arteriose Monitorate E Loro Associazioni study, we measured, along with SUA, metabolic, renal, and anthropometric variables, left-ventricular mass index, and office, home and ambulatory BP. Cardiovascular and all-cause mortality was assessed over a 16-year follow-up period, and measurements were repeated 10 years after the initial data collection.

Results: Baseline SUA had a near-normal distribution, with a mean value of 4.9 ± 1.3 (SD) mg/dl and a significant direct relationship with BP and metabolic variables, serum creatinine and left-ventricular mass index. It was among the factors independently predicting new-onset home and ambulatory hypertension, the increased risk of developing these conditions for 1 mg/dl increase of SUA after adjustment for all available potential confounders being 34 and 29%, respectively (P = 0.015 and P = 0.014). An increase in SUA of 1 mg/dl also independently predicted cardiovascular and all-cause mortality, the fully adjusted increase in risk being 22% (P = 0.03) and 12% (P = 0.04), respectively.

Conclusion: In the general population of the Pressioni Arteriose Monitorate E Loro Associazioni study, SUA correlated with a number of cardiovascular risk factors. Nevertheless, it independently predicts new-onset out-of-office hypertension, and long-term cardiovascular and all-cause mortality.

aClinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza, Monza e Brianza

bCentro Interuniversitario di Fisiologia Clinica ed Ipertensione – Università Milano-Bicocca, Milano e Pavia, Milan

cIstituto Auxologico Italiano, Milan

dIRCCS Multimedica, Sesto San Giovanni, Milan, Italy

Correspondence to Giuseppe Mancia, Clinica Medica Ospedale S. Gerardo, Via Pergolesi 33, 20090 Monza, Italy.Tel: +39 039 233 3357; fax: +39 039 322274; e-mail:

Abbreviations: BP, blood pressure; HDL, high-density lipoprotein; LVMI, left-ventricular mass index; PAMELA, Pressioni Arteriose Monitorate E Loro Associazioni; ROC, receiver-operating characteristic curve; SUA, serum uric acid

Received 31 October, 2013

Revised 10 January, 2014

Accepted 3 February, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins