Hyperuricemia as an Independent Risk Factor for Hypertension and Cardiovascular Events: A Meta-Analytic Review

Abstract

Introduction: Elevated serum uric acid (SUA) is frequently observed in hypertensive patients, but causality remains debated. This review synthesizes evidence linking hyperuricemia to incident hypertension and cardiovascular disease (CVD) events.
Methods: PubMed, Embase, and Cochrane Library were searched up to December 2023 for prospective cohort studies and randomized trials. Inclusion: adults without baseline CVD, SUA measured, follow-up ≥1 year. Exclusion: gout treatment at baseline. Data extracted by two reviewers. Random-effects meta-analysis performed.
Results: 28 studies (n=210,876) included. Pooled adjusted HR for incident hypertension per 1 mg/dL increase in SUA was 1.13 (95%CI 1.08–1.18). For CVD events (MI, stroke, CVD death), HR was 1.12 (95%CI 1.07–1.16). Dose-response analysis showed linear relationship up to 8 mg/dL. Subgroup analysis: stronger effect in women (HR 1.18 vs. 1.10 in men).
Discussion: Mechanistically, uric acid may induce endothelial dysfunction, activate renin-angiotensin system, and promote oxidative stress. Residual confounding (e.g., diet, renal function) limits causal inference. Few trials tested urate-lowering therapy for primary prevention; those did not show consistent benefit.
Conclusions: Hyperuricemia modestly but consistently predicts incident hypertension and CVD events, particularly in women. Whether urate lowering reduces cardiovascular risk requires dedicated randomized controlled trials.