Study does not support urate lowering for managing hypertension in young people

Urate-lowering therapy with allopurinol does little to reduce blood pressure (BP) or inflammation levels in young adults despite improvements in flow-mediated dilation (FMD), according to a study.

The study enrolled 99 adults (mean age 28 years, 62.6 percent male, 40.4 percent African American) with baseline systolic BP ≥120 and <160 mm Hg or diastolic BP ≥80 and <100 mm Hg, and serum urate ≥5.0 mg/dl in men or ≥4.0 mg/dl in women. None of them had chronic kidney disease, gout, or previous exposure to urate-lowering therapies.

The patients were randomized to receive oral allopurinol (300 mg daily) or placebo for 1 month, followed by a 2–4-week washout and then were crossed over to the alternative treatment. A total of 82 patients completed the trial.

In the primary intent-to-treat population, allopurinol produced no significant reduction in systolic BP as compared with placebo (mean −1.39 vs −1.06 mm Hg). High sensitivity C-reactive protein level barely changed in the two treatment groups.

FMD, however, improved substantially during urate-lowering treatment (mean 2.5 percent vs −0.1 percent during placebo treatment; p<0.001).

None of the patients developed serious adverse events.

These data do not support urate lowering in the management of hypertension in young adults.