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This study aims to find which definition of metabolic syndrome best predicts hypertension-mediated organ damage in children and adolescents and if adding serum uric acid improves this prediction.

June 3, 2026

Uric Acid as an Addictional Component of Metabolic Syndrome – Its Association With Hypertension-Mediated Organ Damage

Key Points

This study aims to find which definition of metabolic syndrome best predicts hypertension-mediated organ damage in children and adolescents and if adding serum uric acid improves this prediction.
Included 420 children aged 10-18 with confirmed hypertension based on ambulatory blood pressure monitoring.
Conducted anthropometric assessments, biochemical testing (serum uric acid), and office/ambulatory blood pressure measurements.
Evaluated organ damage through carotid intima-media thickness, left ventricular mass index, and pulse wave velocity.
14.5% of participants met the metabolic syndrome criteria according to IDF; alternative definitions modestly increased prevalence to 21.7%-26.7%.
Patients with metabolic syndrome had higher carotid intima-media thickness (0.45 mm vs 0.43 mm; p = 0.012) and increased left ventricular mass index linked to the number of metabolic syndrome criteria met.
Incorporating elevated serum uric acid significantly improved prediction of left ventricular hypertrophy, increasing kappa agreement from 0.086 to 0.190 (p < 0.001).

Abstract

Objective: Our study aimed to identify the metabolic syndrome (MS) definition with the highest prognostic value of hypertension-mediated organ damage (HMOD) among children and adolescents diagnosed with arterial hypertension (HT) and to assess whether inclusion of serum uric acid (UA) concentration improves this prediction. Design and method: 420 children aged 10-18 years with confirmed HT based on ambulatory blood pressure monitoring (ABPM) were included. All patients underwent anthropometric assessment, biochemical testing including serum UA concentration, office blood pressure (BP) measurement, and ABPM. HMOD was evaluated by measuring carotid intima-media thickness (cIMT), left ventricular mass index (LVMi), and pulse wave velocity (PWV). MS was defined by International Diabetes Federation (IDF) criteria and definitions proposed by Cook et al. , Ford et al. , De Ferranti et al. and Agudelo et al. Results: The overall prevalence of MS according to IDF criteria was 14. 5%. Applying alternative MS definitions generally caused only a modest increase in prevalence (21. 7%–26. 7%) except for the De Ferranti definition which identified a substantially higher estimated MS prevalence (50. 2%). Patients with MS presented higher cIMT (0. 45 vs 0. 43 mm; p = 0. 012) and cIMT-SDS values (1. 26 vs 0. 88; p = 0. 003). LVMi increased with the number of fulfilled MS criteria (including HT), reaching the highest values in patients meeting four criteria compared with those with HT alone (39. 15 vs 34. 31 g/m². 7; p = 0. 03). Serum UA concentrations were higher in MS patients (6. 3 vs 5. 7 mg/dL; p 6. 4 mg/dL), as the kappa agreement between patients identified by the modified definition and those with confirmed LVH increased from 0. 086 to 0. 190 (p < 0. 001). Conclusions: MS is associated with early vascular and organ damage in hypertensive children, with risk increasing alongside the number of MS components. Inclusion of serum UA enhances prediction of LVH and may improve early risk stratification for HMOD.

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Uric Acid as an Addictional Component of Metabolic Syndrome – Its Association With Hypertension-Mediated Organ Damage

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