High prevalence of asymptomatic hyperuricemia in rural population is associated with hypertensive status

Objective: The serum uric acid (SUA) has an important role in the pathogenesis of hypertension, and it is associated with risk for cardiovascular (CV) morbidity and mortality. There is no consensus for treatment of asymptomatic SUA. The aim of our study was to investigate prevalence and predictors for asymptomatic hyperuricemia in general rural adult population (ENAH rural study). Design and method: In this cross-sectional survey we included 773 from the original ENAH cohort (men 34.8%, average age 59 ys) who completed structured questionnaire, were clinically examined, fasting blood was drawn and urine samples were collected. Blood pressure (BP) was measurement according to the ESH guidelines. Subjects were divided into 4 groups: treated controlled hypertensives (TCHT 25.4%), treated uncontrolled hypertensives (TUHT 24.9%), untreated hypertensives (UTHT 14.2%) and untreated normotensives (UTNT 35.3%). Thresholds values for hyperuricemia were defined as >333 umol/L for men and >300 umol/L for women. Results: The prevalence of hyperuricemia was 45.5%. It was more common in men, subjects with eGFR CKD EPI < 60 ml/min/1.73 m2, TCHT/TUHT, those with uricostatics, and diuretic therapy (52%, p<0.001; 18%, p<0.001; 68%, p<0.001; 11%, p=0.01; 6%, p=0.002, respectively). Subjects with hyperuricemia were older, had higher values of BP and lower eGFR CKD Epi (p<0.001 for all). In bivariate logistic regression, age, male gender, SBP/DBP, hypertensive status (TUHT>TCHT>UNHT), and diuretic therapy increase, while antihypertensive therapy and eGFR CKD Epi >60 ml/min/1.73 m2 decrease the risk for hyperuricemia. With the progression of CKD, risk for hyperuricemia increases, starting from CKD G2 (p<0.001). In multivariate logistic regression, only male gender, and hypertensive status (TCHT >TUHT> UNHT) increase the odds for hyperuricemia, TCHT {OR 4.69, 95% CI (2.98 – 7.40), p<0.001} and TUHT {OR 4.37, 95%CI (2.7-6.82), p<0.001} being the most predictive. Conclusions: The prevalence of asymptomatic hyperuricemia in rural population is very high. Male gender and hypertensive status independently increase the risk for hyperuricemia in Croatian rural population.