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(Hypertension. 2005;45:18.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

Resurrection of Uric Acid as a Causal Risk Factor in Essential Hypertension

From the Division of Nephrology (R.J.J.), Hypertension and Transplantation, University of Florida, Gainesville; Texas Children’s Hospital, (D.I.F.) Baylor College of Medicine, Houston; Instituto de Cardiologia (J.H.-A.), Mexico City, Mexico; and Division of Nephrology (D.-H.K.), Ewha University College of Medicine, Seoul, Korea.

Correspondence to Richard J. Johnson, Division of Nephrology, Hypertension, and Transplantation, PO Box 100024, University of Florida, Gainesville FL 32610. johnsrj@medicine.ufl.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In his landmark paper describing the entity of essential hypertension, Frederick Akbar Mahomed observed that many hypertensive subjects came from gouty families, leading him to suggest uric acid as a causal factor in the blood pressure response.¹ Ten years later this hypothesis was championed by Haig, who proposed low purine diets as a means to prevent hypertension and vascular disease.² During the same period the French academician, Henri Huchard, noted that renal arteriolosclerosis (the histological lesion of hypertension) was primarily observed in 3 groups: those with gout or lead poisoning or those with a diet enriched in fatty meat, all conditions associated with hyperuricemia.³

During the early 1900s there continued to be reports linking uric acid with hypertension.⁴ In the 1960s and 1970s, at a time when hyperuricemia was present in 5% of the US population,⁵ an elevated uric acid level was observed in 40% to 60% of hypertensive subjects⁶; similarly, hypertension was observed in 50% to 65% of subjects with gout.⁷ Cannon et al reported that hyperuricemia was observed in 25% of untreated hypertensive subjects, 50% of those on treatment, and 75% to 100% of those with malignant hypertension or renal dysfunction.⁸ Population-based studies also found an increased frequency of hypertension with stepwise increases in serum uric acid levels in both blacks and whites.⁹

Whereas these studies confirmed initial impressions of a close association of uric acid with hypertension, the studies did not address causality. Indeed, most authorities proposed that the presence of hyperuricemia in the hypertensive subject . . . [Full Text of this Article]

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