Serum uric acid and cardiovascular events in successfully treated hypertensive patients
Serum uric acid and cardiovascular events in successfully treated hypertensive patients
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DOI：
10.1161/01.hyp.34.1.144
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发表时间：
1999-07-01
期刊：
影响因子：
8.3
通讯作者：
Kivlighn, S
中科院分区：
文献类型：
--
作者：
Alderman, MH;Cohen, H;Kivlighn, S
为了确定治疗前和/或治疗中血清尿酸（SUA）是否与高血压患者的心血管事件独立和特异性相关，我们检查了7978例轻度至中度高血压参与者在一个系统的工作场所治疗计划的20年经验。临床评估和治疗是方案指导的。测量SUA。入职时及其后每年。根据基线SUA的性别-特异性四分位数对受试者进行分层。入组时和治疗期间的血压分别为152.5/95.6和138.9/85.4 mm Hg。SUA呈正态分布，男性和女性的平均值分别为0.399 +/- 0.0893和0.321 +/- 0.0833 mmol/l。SUA最高的受试者体重较重，有：心血管疾病（CVD）证据较多，收缩压较高，肌酐较高，利尿剂使用频率较高，糖尿病患病率较低，在平均6.6年（52751患者年）的随访期间，发生了548起CVD事件（183例死亡）和116起非CVD事件。在双变量分析中，SUA与CVD的相关性在非白人中比白人更强，并且在低与高CVD风险的患者中更强。在多变量分析中，CVD发病率与SUA显著相关，风险比为1.22（95%置信区间为1.11至1.35），控制了其他已知的心血管危险因素，包括血清肌酐、体重指数和糖尿病使用。尽管血压得到控制，但SUA水平在治疗期间升高，并与CVD事件显著直接相关，与利尿剂使用和其他心血管危险因素无关。
To determine whether pretreatment and/or in-treatment serum uric acid (SUA) is independently and specifically associated with cardiovascular events in hypertensive patients, we examined the 20-year experience of 7978 mild-to-moderate hypertensive participants in a systematic worksite treatment program. Clinical-evaluation and treatment were protocol-directed. SUA was measured. at entry and annually thereafter. Subjects were stratified according to gender-specific quartile of baseline SUA. Blood pressures at entry and in-treatment were, respectively, 152.5/95.6 and 138.9/85.4 mm Hg. SUA was normally distributed with a mean of 0.399 +/- 0.0893 and 0.321 +/- 0.0833 mmol/l for men and women, respectively. Subjects with highest SUA were heavier, had: greater evidence of cardiovascular disease (CVD), higher systolic blood pressure, higher creatinine, more frequent diuretic use, and lower prevalence of diabetes, During an average follow-up of 6.6 years (52 751 patient-years); 548 CVD events (183 mortal) and 116 non-CVD events occurred. In bivariate analysis, the association of SUA to CVD was more robust in nonwhites than whites and in patients at low versus high CVD risk. In multivariate analysis, CVD incidence was significantly associated with SUA with a hazard ratio of 1.22 (95% confidence interval 1.11 to 1.35), controlling:for other known cardiovascular risk factors, including serum creatinine, body mass index, and diuetic use. Despite blood pressure control, SUA levels increased during treatment and were significantly and directly associated with CVD events, independently of diuretic use and other cardiovascular risk factors.