Relation of serum uric acid to an exaggerated systolic blood pressure response to exercise testing in men with normotension

Diastolic and systolic blood pressure and gout: a Mendelian randomization study

Background

Although there is solid epidemiological evidence supporting the connection between hypertension and gout, little has been said about the relationship between diastolic and systolic blood pressure and gout, the causal relationship and direction associated are uncertain, so we aim to research the causal relationship between diastolic and systolic blood pressure and gout.

Methods

We conducted a two-sample Mendelian randomization (MR) analysis to assess the causal effect between 2 blood pressure phenotypes (including diastolic blood pressure and systolic blood pressure) and 5 gout phenotypes (including gout, drug-induced gout, idiopathic gout, unspecified gout, and strictly defined gout) using genome-wide association study statistics. The inverse variance weighting method was used to generate the main results, while sensitivity analyses using MR-Egger, weighted median, Cochran's Q test, Egger intercept test, and leave-one-out analysis, were performed to assess the stability and reliability of the results.

Results

After the screening, we found a causal relationship between diastolic blood pressure and gout, idiopathic gout, unspecified gout, and strictly defined gout, and a causal relationship between systolic blood pressure and gout, idiopathic gout, unspecified gout, and strictly defined gout.

Conclusion

From a genetic predisposition, controlling blood pressure may reduce the risk of gout.

Uric acid mediated the relationship between obesity and hypertension in children and adolescents: A population‑based cohort study

BACKGROUND AND AIM

Obesity and hyperuricemia (HUA) often coexist and have been widely accepted as risk factors for hypertension, but the role of uric acid (UA) in the relationship between obesity and hypertension remains unknown in children and adolescents.

METHODS AND RESULTS

A total of 7525 subjects aged 6-16 years were from the School-based Cardiovascular and Bone Health Promotion Program (SCVBH) at baseline (2017) and followed up in 2019. Multivariable logistic regression with interaction terms, cross-lagged panel analysis, and causal mediation model were applied to delineate the joint impact of obesity and HUA on hypertension, including the interaction effect, the temporal association, and the mediating effect of UA in the relationship between obesity and hypertension. There were 10.8 % of the participants with normotension at baseline developed hypertension after two years of follow-up. Cross-lagged panel analysis showed that the two-time point association was significant only from baseline BMI to follow-up UA (β1 = 0.302, P < 0.001), but not from baseline UA to follow-up BMI (β2 = 0.002, P = 0.745). Multivariable logistic regression showed that both obesity and HUA increased the risk of hypertension, but no interaction effect between HUA and obesity. The causal mediation analysis found that UA partially mediated the association between BMI and SBP (mediate proportion: 20.3 %, 95 % CI: 17.4-22.9 %) or DBP (mediate proportion: 11.9 %, 95 % CI: 3.9-18.2 %). The results were consistent in the analysis of systolic hypertension rather than diastolic hypertension.

CONCLUSIONS

It is mediating effect that UA played in the progress from obesity to hypertension, particularly systolic hypertension in children and adolescents.

Deep phenotype characterization of hypertensive response to exercise: implications on functional capacity and prognosis across the heart failure spectrum

AIMS

Limited evidence is available regarding the role of hypertensive response to exercise (HRE) in heart failure (HF). We evaluated the systolic blood pressure (SBP) to workload slope during exercise across the HF spectrum, investigating haemodynamic and prognostic correlates of HRE.

METHODS AND RESULTS

We prospectively enrolled 369 patients with HF Stage C (143 had preserved [HFpEF], and 226 reduced [HFrEF] ejection fraction), 201 subjects at risk of developing HF (HF Stages A-B), and 58 healthy controls. We performed a combined cardiopulmonary exercise stress echocardiography testing. We defined HRE as the highest sex-specific SBP/workload slope tertile in each HF stage. Median SBP/workload slope was 0.53 mmHg/W (interquartile range 0.36-0.72); the slope was 39% steeper in women than men (p < 0.0001). After adjusting for age and sex, SBP/workload slope in HFrEF (0.47, 0.30-0.63) was similar to controls (0.43, 0.35-0.57) but significantly lower than Stages A-B (0.61, 0.47-0.75) and HFpEF (0.63, 0.42-0.86). Patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction. After a median follow-up of 16 months, HRE was independently associated with adverse outcomes (all-cause mortality and hospitalization for cardiovascular reasons: hazard ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak SBP were not. Kaplan-Meier analysis confirmed a worse survival probability in Stages A-B (p = 0.005) and HFpEF (p < 0.001), but not HFrEF.

CONCLUSION

A steeper SBP/workload slope is associated with impaired functional capacity across the HF spectrum and could be a more sensitive predictor of adverse events than absolute SBP values, mainly in patients in Stages A-B and HFpEF.

Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model

BACKGROUND

Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout.

OBJECTIVE

We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model.

METHOD

A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting.

RESULT

We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48-7.09) and an AOR of 4.44 (95% CI: 3.07-6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02-0.08], p < 0.001).

CONCLUSION

Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.