Uric Acid Lowering Treatment of Patients With Chronic Heart Failure

Hyperuricemia (HU) is important and common comorbidity that often coexist in patients with heart failure (HF). High values of serum uric acid are associated to severe heart failure. The purpose of the present study was to evaluate a UA-lowering and prognostic effects of allopurinol in patients with chronic HF and hyperuricemia.We studied 75 patients with HF and increased UA levels, who have been admitted to hospital. All patients aged 18 years and older were eligible, provided a left ventricular ejection fraction of 45% or less was documented on echocardiography during the enrolment visit and signs and symptoms of chronic heart failure were present. Patient baseline assessment included a standardized HF history regarding HF aetiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class, determination of body weight. Blood samples were drawn from an antecubital vein in the morning for the assessment of a full blood count and clinical chemistry. Patients were divided in to two groups:  50 patients (group 1) received allopurinol. The initial dose of in most patients was 200 mg/day and it was reduced according to their renal function or UA level. 25 patients (group 2) – controlled group. Treatment duration was 6 months.Repeated studies after 3 months showed the following results: Uric acid treatment improved the echocardiographic parameters (LVEF, LV mass index, IVS, PW, stroke volume), reduced NT- proBNP, improved renal function, Improved NYHA functional class;6-minute walking test distance improved significantly in the UA- treatment group and quality of life. The QoL parameters that was improved included reduced physical limitation, improved mobility, selfcare, increased daily activities and reduced discomfort, anxiety and depression.Among patients with HF and elevated serum uric acid levels, allopurinol use was safe and strongly associated with improved outcomes.