Department of Medicine and Surgery.
Clinica Medica, University of Milano-Bicocca.
J Hypertens. 2019 Apr;37(4):844-850. doi: 10.1097/HJH.0000000000001951.
Whether increased serum uric acid (SUA) favours resistance to antihypertensive drugs is not clear.
The European Lacidipine Study on Atherosclerosis (ELSA) was a randomized, double-blind, multicenter trial comparing the effects of a 4-year treatment with either lacidipine or atenolol on progression of carotid atherosclerosis in patients with moderate hypertension. SUA was assessed at randomization and at the study end, office blood pressure (BP) was measured at each titration visit and every 6 months thereafter, ambulatory BP was measured at randomization and every year thereafter.
No difference was found in office and ambulatory BP reduction achieved after 1 and 4 years of treatment in baseline SUA tertiles. This was the case for both treatments. The percentage of patients with controlled office BP (<140/90 mmHg) after 1 year (36.5, 34.2 and 33.8%, P = 0.56) and 4 years (39.9, 39.4 and 38%, P = 0.82) was not different in SUA tertiles. Similar results were obtained basing the analysis on the control of ambulatory BP (<130/80 mmHg) or when data were analyzed taking into account SUA extreme values (≥7 and <3.5 mg/dl). The average and percentage changes of SUA (baseline-study end) were not different between patients who achieved or did not achieve office BP control (5.31 ± 1.26 vs. 5.4 ± 1.29 mg/dl, P = 0.22 e 0.13 ± 0.33 vs. 0.13 ± 0.68, P = 0.87, respectively). This was the case also for control of ambulatory BP.
In the ELSA study, SUA levels do not affect the responsiveness to antihypertensive treatment.
血尿酸（SUA）升高是否有利于抵抗降压药物尚不清楚。
欧洲拉西地平动脉粥样硬化研究（ELSA）是一项随机、双盲、多中心试验，比较了 4 年拉西地平或阿替洛尔治疗对中度高血压患者颈动脉粥样硬化进展的影响。在随机分组时和研究结束时评估 SUA，在每次滴定就诊时测量诊室血压（BP），此后每 6 个月测量一次，在随机分组时和此后每年测量一次动态血压。
在基线 SUA 三分位组中，治疗 1 年和 4 年后，诊室和动态血压的降低无差异。两种治疗均如此。治疗 1 年后（36.5%、34.2%和 33.8%，P=0.56）和 4 年后（39.9%、39.4%和 38%，P=0.82），诊室 BP 控制（<140/90mmHg）的患者百分比在 SUA 三分位组中无差异。基于对动态 BP 控制（<130/80mmHg）的分析或在考虑 SUA 极值（≥7 和 <3.5mg/dl）时进行分析，得到了相似的结果。在达到或未达到诊室 BP 控制的患者中，SUA（基线-研究结束）的平均和百分比变化无差异（5.31±1.26 vs. 5.4±1.29mg/dl，P=0.22 和 0.13±0.33 vs. 0.13±0.68，P=0.87）。这同样适用于对动态 BP 的控制。
在 ELSA 研究中，SUA 水平不影响对降压治疗的反应性。
