Recently, the consensus on the management of hypertension with asymptomatic hyperuricemia suggests that patients with hypertension should routinely check blood uric acid . For patients with hypertension with metabolic syndrome, diabetes and family genetic history of hyperuricemia, blood uric acid testing should be actively carried out.
consensus suggests that for patients with asymptomatic hematologic uric acid combined with cardiovascular risk factors and cardiovascular disease, it is recommended to conduct a 10-year cardiovascular risk assessment, and blood uric acid should be controlled for a long time <360>
Hyperuricemia in adults refers to the uric acid level of fasting blood in normal diet, regardless of men or women, two fasting blood on the same day >420 μmol/L.
Asymptomatic hyperuricemia refers to the situation in which the patient only has hyperuricemia but does not have symptoms such as arthritis.
Hyperuricemia among Chinese people is 13.3%, and it is mostly coexisting with hypertension.
Figure 1 Hypertension combined with hyperuricemia management flow chart
High purine diets should be restricted for hyperuricemia, such as animal viscera, seafood, nuts, soybeans, etc. In addition, beverages and fruits with high fructose content should be controlled, and alcohol consumption should be strictly restricted, especially beer and white wine.
In addition to a low-purine diet, controlling body mass, reducing insulin resistance, drinking plenty of water and properly alkalizing urine can also reduce blood uric acid levels.
Hypertension with various cardiovascular risk factors or Hyperuricemia in patients with chronic kidney disease is required when lifestyle intervention is effective. If blood uric acid is still high, it is recommended to use uric acid-lowering drugs.
For patients with hypertension and asymptomatic hyperuricemia, blood uric acid needs to be checked multiple times to find the cause, and emphasize the improvement of various risk factors related to elevated uric acid through lifestyle intervention to reduce blood uric acid.
In addition, for patients with hypertension and hyperuricemia, first determine whether antihypertensive drugs (such as diuretics) that increase blood uric acid and other drugs that increase blood uric acid are used.
If there is any, correction is required. Pay attention to the control of blood pressure . Hyperuricemia will occur if blood pressure is poor or excessive control is used. Reasonable blood pressure control is conducive to the improvement of hyperuricemia.
patients with hypertension have increased blood uric acid. It is recommended to select antihypertensive drugs and cardiovascular drugs with uric acid effects, which can both lower blood pressure and help lower blood uric acid to a certain extent.
Before using allopurinol , you need to ask about the allergy history. If necessary, perform the relevant gene test . Febulista is more suitable for patients with hyperuricemia in chronic kidney disease. Long-term use should pay attention to the risk of cardiovascular disease.
benzenebromalone 50 mg/d is beneficial to the excretion of uric acid in patients with hyperuricemia.
Severe renal impairment (eGFR <>2) and patients with uricidal renal stones are contraindicated.
When the use of a single uric acid-lowering drug cannot achieve the blood uric acid standard, combined treatment can be considered after evaluation of safety, that is, xanthine oxidase inhibitors are combined with uric acid excretion drugs.
Source: Consensus Expert Group of the Hypertension Branch of the China Association for the Promotion of International Healthcare Exchanges. Consensus of Chinese Experts on Management of Hypertension with Asymptomatic Hyperuricemia. Chinese Journal of Hypertension , 2022, 11: 1014-1019.
Reprinted: Please indicate "China Circulation Magazine"
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