[OP.5B.03] TIME TO IMPLEMENT SERUM URIC ACID FOR RISK STRATIFICATION IN HYPERTENSIVE WOMEN? LONG-TERM FOLLOW-UP DATA IN THE OLD-HTA COHORT. (September 2017)

• Record Type: Journal Article
• Authors: Courand, P.Y.; Berge, C.; Milon, H.; Harbaoui, B.; Lantelme, P.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523093.33698.db
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Albeit controversial, serum uric acid (SUA) seems to convey a prognostic significance in women. Yet data over the long run are limited in hypertension. The aim of the present study was to confirm the prognostic significance over the long-term particularly in hypertensive women. Design and method: 1897 hypertensive patients with an assessment of SUA at baseline during their work-up for hypertension were followed according to tertile of SUA: < 339, 339 to 428 and >428 micromol/L. All-cause and cardiovascular mortalities were assessed after a 20 year-follow-up period. Results: Baseline characteristics were age 45.1 ± 13.4 years, systolic/diastolic blood pressure 180 ± 32/104 ± 20 mmHg, women 39.1% and eDFG 83.3 ± 29.5 mL/min. SUA was independently correlated with age, gender, BMI, previous cardiovascular events, eGFR, thiazide diuretics and beta-blockers use, and diabetes. At 20 years of follow-up, 748 deaths were observed, 442 of which were from cardiovascular causes. As shown in Kaplan-Meier curves, tertiles of SUA were predictor of all-cause and cardiovascular death in the whole cohort (p < 0.001 for both, Figure). In multivariate Cox regression analysis, patients in the third tertile have an increased risk of all-cause death (HR 1.34 (1.09–1.65) vs. tertile 1, HR 1.30 (1.09–1.55) vs. tertile 2) but only a trend was observed for cardiovascular death (HR 1.33 (1.00–1.76) vs. tertile 1, HR 1.16 (0.92–1.53) vs. tertile 2). A strong interaction with gender was observed for all-cause and cardiovascular mortality (p = 0.006 and p = 0.013 respectively). In subgroup analysis with the same Cox regression analysis, tertile 3 predicts mortality only in women: all-cause death HR 1.86 (1.34–2.58) vs. tertile 1, HR 1.76 (1.25–2.48) vs. tertile 2; cardiovascular death HR 1.77 (1.13–2.79) vs. tertile 1, HR 1.52 (0.96–2.38) vs. tertile 2. The information gain after addition of tertiles of SUA was significant in the multivariable Cox regression model (likelihood ratio test p = 0.009 and p = 0.025 for all-cause and cardiovascular mortality, respectively) with an increment of the C-index of 0.003 for the two different endpoints. Figure. No caption available. Conclusions: After a long-term follow-up period, SUA improves death stratification in hypertensive women on top of traditional risk factors and target organ damages.