Link between hyperuricemia, renal dysfunction, and hypertension

The abnormalities in uric acid concentration are common in a variety of clinical settings.Uric acid, a byproduct of purine metabolism, was influenced by several factors, such as high purine or protein diets, alcohol consumption, conditions with high cell turnover, drugs, renal dysfunction, or enzymatic defects in purine metabolism.Further, the development of hypertension, 1 renal dysfunction, 2 and cardiovascular events 3 have all been linked to an increase in serum uric acid.In the mechanistic insight, hyperuricemia was discovered to enhance various pathologic conditions by regulating several signals, such as inflammatory response, oxidative stress, insulin resistance/diabetes, endoplasmic reticulum stress, and endothelial dysfunction.4 However, there had been long-term controversies about the clinical significance of hyperuricemia.In addition, the clinical efficacy of lowering serum uric acid had been clearly established.In this issue of the Journal of Clinical Hypertension, Kawazoe and coworkers examined the risk of new-onset hypertension based on serum uric acid levels using a population-based cohort over a relatively long follow-up period, and the study demonstrated the association between hyperuricemia and new-onset hypertension.5 Furthermore, high uric acid levels increased the risk of developing new-onset hypertension in the presence of chronic kidney disease.High uric acid levels have been linked to an increased risk of hypertension.According to a meta-analysis of 18 prospective cohort studies, the incidence of hypertension increased by 13% per 1 mg/dl increase in serum uric acid level.6 Moreover, a long-term follow-up longitudinal study supports the finding.7 However, the association between high uric acid and hypertension differed between populations.Grayson and coworkers discovered that the association was stronger in younger population.6 On the other hand, estrogen may have a protective effect against high levels of uric