Urate-lowering therapy benefits do not extend to young hypertensives

Among young adults with hypertension, treatment with the urate-lowering drug allopurinol appears to improve endothelial function, although this does not translate to meaningful reductions in blood pressure (BP) or inflammation levels, as shown in a study.

The single‐centre, double‐blind, randomized, crossover clinical trial enrolled adults aged 18–40 years who had hypertension (defined as baseline systolic BP (SBP) ≥120 and <160 mm Hg or diastolic BP (DBP) ≥80 and <100 mm Hg) and serum urate levels of ≥5.0 mg/dL for men or ≥4.0 mg/dL for women. None of the participants had chronic kidney disease, gout, or previous exposure to urate‐lowering therapies.

A total of 99 patients were randomized to receive oral allopurinol (300 mg daily) or placebo for 1 month then crossed over to the alternative treatment following a 2–4-week washout period. Efficacy was assessed based on changes in SBP from baseline, endothelial function (estimated as flow‐mediated dilation [FMD]), and high‐sensitivity C‐reactive protein (hs‐CRP) levels. Safety was also assessed.

Of the patients, 82 completed all visits. The mean age of the population was 28.0 years; 62.6 percent of them were men, and 40.4 percent were African American.

In the primary intention‐to‐treat analysis, SBP did not differ between the two treatment periods. Specifically, there was a mean reduction of 1.39 mm Hg with allopurinol and of 1.06 mm Hg with placebo.

On the other hand, urate-lowering therapy produced an increase in FMD compared with placebo (mean, 2.5 percent vs –0.1 percent; p<0.001).

There were no important changes seen in hs‐CRP and no serious adverse events documented.

The present data do not support the use of urate‐lowering in the treatment of hypertension in young adults.