Bigotte Vieira Miguel, Baptista Rute Baeta, Costa João, Vaz-Carneiro António
Serviço de Nefrologia e Transplantação Renal. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
Pediatria Médica. Área da Mulher, Criança e Adolescente. Hospital de Dona Estefânia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. Departamento de Fisiopatologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal.
Acta Med Port. 2017 May 31;30(5):356-360. doi: 10.20344/amp.9173.
Arterial hypertension is a public health problem that affects approximately 25% of the world's adult population. The association between hypertension and hyperuricemia has been shown on epidemiological and experimental studies. However, it is unclear whether lowering serum uric acid might lower blood pressure. This Cochrane systematic review - a revised edition of a previously published one - intended as primary objective to evaluate the effect of hypouricemic drugs in patients with primary hypertension or prehypertension. The secondary objectives were to evaluate the efficacy and safety of hypouricemic drugs. A systematic search until February 2016 on controlled, randomized or quasi-randomized trials comparing the effect of hypouricemic drug versus placebo in hypertensive or prehypertensive patients was performed on the following databases: The Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, The World Health Organization International Clinical Trials Registry Platform, e ClinicalTrials.gov. LILACS database up to March 2016 was also searched and the authors of relevant studies were contacted. There were 349 identified papers, 21 were preselected and three randomized clinical trials (211 patients) were included in the qualitative analysis and in the meta-analysis. Two of the trials were conducted exclusively on adolescents. The authors conclude that hypouricemic drugs are not effective in lowering blood pressure in patients with hyperuricemia and primary prehypertension or hypertension. However, this strategy might be more effective in the specific population of adolescents with prehypertension or mild primary hypertension recently diagnosed. Hypouricemic drugs effectively reduce serum uric acid level and withdrawals of therapy due to adverse effects were not superior in the treated group, comparing to placebo; however, one patient withdrew due to a severe cutaneous reaction.
动脉高血压是一个影响全球约25%成年人口的公共卫生问题。流行病学和实验研究已表明高血压与高尿酸血症之间存在关联。然而，尚不清楚降低血清尿酸是否会降低血压。本Cochrane系统评价——先前发表版本的修订版——旨在作为主要目标评估降尿酸药物对原发性高血压或高血压前期患者的疗效。次要目标是评估降尿酸药物的疗效和安全性。截至2016年2月，我们在以下数据库中进行了系统检索，以查找比较降尿酸药物与安慰剂对高血压或高血压前期患者疗效的对照、随机或半随机试验：Cochrane高血压专业注册库、Cochrane对照试验中央注册库（CENTRAL）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、世界卫生组织国际临床试验注册平台、美国国立医学图书馆临床试验数据库（e ClinicalTrials.gov）。我们还检索了截至2016年3月的拉丁美洲和加勒比地区健康科学文献数据库（LILACS），并联系了相关研究的作者。共识别出349篇论文，预先筛选出21篇，3项随机临床试验（211例患者）纳入定性分析和荟萃分析。其中2项试验仅在青少年中进行。作者得出结论认为，降尿酸药物对高尿酸血症合并原发性高血压前期或高血压患者降低血压无效。然而，该策略可能对最近诊断为高血压前期或轻度原发性高血压的特定青少年人群更有效。降尿酸药物可有效降低血清尿酸水平，与安慰剂相比，治疗组因不良反应而停药的情况并不更严重；然而，有1例患者因严重皮肤反应而停药。
